The risk of carotid artery stenting compared with carotid endarterectomy is greatest in patients treated within 7 days of symptoms

Rantner, Barbara; Goebel, Georg; Bonati, Leo H.; Ringleb, Peter; Mas, Jean‐Louis; Fraedrich, Gustav

doi:10.1016/j.jvs.2012.08.107

Cited by 109 publications

(63 citation statements)

References 27 publications

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“…22 In addition, another single-center trial and a subgroup analysis by guest on May 7, 2018 http://stroke.ahajournals.org/ Downloaded from of the Carotid Stenosis Trialists' Collaboration data performed multivariable regression analyses comparing patients treated within 7 days after the index event with patients treated later. 23,24 In accordance with the present analysis, neither study found any significant association between the time interval and the 30-day risk of any stroke or death. In contrast, the Swedish register study by Strömberg et al 10 found a significantly increased perioperative risk of stroke or death when the procedure was performed within the first 2 days after the index event.…”

Section: Discussionsupporting

confidence: 88%

Short Time Interval Between Neurologic Event and Carotid Surgery Is Not Associated With an Increased Procedural Risk

Tsantilas¹,

Kuehnl²,

König³

et al. 2016

Stroke

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Background and Purpose— Guidelines recommend that carotid endarterectomy should be performed within 2 weeks in patients with a symptomatic carotid stenosis. Because a Swedish register study indicated that patients treated within the first days after a stroke or transient ischemic attack might have an increased perioperative stroke and mortality risk, this study aimed to find out whether these findings are also true under everyday conditions in Germany. Methods— Secondary data analysis including 56 336 elective carotid endarterectomy procedures performed for symptomatic carotid stenosis under everyday conditions between 2009 and 2014. The patient cohort was divided into 4 groups according to time interval between index event and surgery (I: 0–2, II: 3–7, III: 8–14, and IV: 14–180 days). Primary outcome was any in-hospital stroke or death. For risk-adjusted analyses, a multilevel multivariable regression model was used. Results— Mean patients’ age was 71.1±9.6 years; 67.5% were men. Overall rate of any stroke or death was 2.5% (n=1434). Risk of any in-hospital stroke or death was 3.0% in group I, 2.5% in group II, 2.6% in group III, and 2.3% in group IV. Multivariable regression analysis revealed that the time interval was not significantly associated with the primary outcome. Conclusions— The time interval between the index event and carotid endarterectomy was not associated with the risk of any in-hospital stroke or death in patients with symptomatic carotid stenosis in Germany. In clinically stable patients, carotid endarterectomy might, therefore, be performed safely as soon as possible after the neurological index event.

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Section: Discussionsupporting

confidence: 88%

Short Time Interval Between Neurologic Event and Carotid Surgery Is Not Associated With an Increased Procedural Risk

Tsantilas¹,

Kuehnl²,

König³

et al. 2016

Stroke

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“…However, postprocedure morbidity and mortality in both treatment arms were high enough to call into question the benefit of either procedure compared with medical management in asymptomatic patients. 358,359 Other RCTs, the EVA-3S (Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis), SPACE (Stent-Supported Percutaneous Angioplasty of the Carotid Artery versus Endarterectomy), and ICSS (International Carotid Stenting Study) trials, have compared CEA and CAS for symptomatic patients. 360 A preplanned meta-analysis of these studies found that the rate of stroke and death at 120 day after randomization was 8.9% for CAS and 5.8% for CEA (HR, 1.53; 95% CI, 1.20-1.95; P=0.0006).…”

mentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Kernan¹,

Ovbiagele²,

Black³

et al. 2014

Stroke

3,946

1,326

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The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

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“…In their study, Rantner et al determined that the risk of CAS, in comparison with CEA, is greatest in patients treated within 7 days of the symptoms. Accordingly early surgery remains the most effective method for stroke prevention in patients with symptomatic carotid artery stenosis (21) . Park et al determined a statistically significant reduction in the length of hospitalization in CAS as against CEA (1.2 vs. 2.1 days), while CAS turned out to be associated with higher total procedural costs ($17.402 vs. $12.112; p<0.029) and direct costs ($10.522 vs. $7227; p<0.017).…”

Section: Discussionmentioning

confidence: 99%

Bölgesel Anestezi Altında Karotis Endarterektomi ile Karotis Arter Stentin Karşılaştırmalı Sonuçları: Retrospektif Analiz ve Literatürün Gözden Geçirilmesi

Günday¹,

Özülkü²,

Saba³

et al. 2014

Khj

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Carotid artery endarterectomy has already gained acceptance as the standard method for treating extracranial carotid artery stenosis. The last 2 decades have witnessed the increasing popularity of minimally invasive endovascular techniques. Patients and Methods: This study involved a retrospective analysis of 41 patients undergoing stent placement in carotid artery and carotid artery endarterectomy between January 2005 and January 2012 due to carotid artery stenosis. The patients were divided into two groups, group 1 (surgery, n=20) and group 2 (stenting, n=21). The two groups were compared with respect to complications, length of hospitalization, and costs. Results: The mean age was 68.35±8.21 years in group 1 and 66.76±9.16 years in group 2. The mean total cost was 2158.00±801.30 TL (Turkish Lira) for group 1 and 6927.86±2884.72 TL for group 2. The mean length of follow-up was 560.05±232.94/ days in the stenting group and was 933.85±505.45 /days in the surgery group. No statistically significant difference was found between the two groups in terms of age, gender, diabetes mellitus, restenosis, mean duration of hospitalization, and mortality (p>0.05). The only difference was observed in the average cost, which turned out to be lower in group 1 than in group 2 (p<0.05). Conclusion:Recently, new alternative stent and filter types have become available, preferred especially in patients with recurrent internal carotid artery stenosis and in those with a history of radiotherapy on the neck. However, when compared with carotid endarterectomy under regional anesthesia is just as safe as stenting and it is also cheaper.

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The risk of carotid artery stenting compared with carotid endarterectomy is greatest in patients treated within 7 days of symptoms

Abstract: The increase in risk of CAS compared with CEA appears to be greatest in patients treated within 7 days of symptoms. Early surgery might remain most effective in stroke prevention in patients with symptomatic carotid artery stenosis.

Cited by 109 publications

References 27 publications

Short Time Interval Between Neurologic Event and Carotid Surgery Is Not Associated With an Increased Procedural Risk

Short Time Interval Between Neurologic Event and Carotid Surgery Is Not Associated With an Increased Procedural Risk

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Bölgesel Anestezi Altında Karotis Endarterektomi ile Karotis Arter Stentin Karşılaştırmalı Sonuçları: Retrospektif Analiz ve Literatürün Gözden Geçirilmesi

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