Trends in the in-hospital stroke rate following carotid endarterectomy in California and Maryland

Matsen, Susanna L.; Chang, David C.; Perler, Bruce A.; Roseborough, Glen S.; Williams, G. M.

doi:10.1016/j.jvs.2006.05.017

Cited by 55 publications

(42 citation statements)

References 32 publications

(29 reference statements)

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“…If the principal discharge diagnosis was "carotid artery stenosis" without mention of stroke and with no accompanying secondary diagnoses for TIA or history of stroke or amaurosis fugax, then the patient was classified as asymptomatic. 21 Primary outcome measures were the occurrence of stroke, myocardial infarction (MI), and all-cause death rates after procedure by 1 year. Stroke was defined by discharge ICD-9 codes of in-hospital "postoperative stroke" (997.0 to 997.01, 997.09) or stroke at rehospitalization after CAS Discrete data are reported as frequencies and compared by 2 and Fisher exact tests as appropriate.…”

Section: Methodsmentioning

confidence: 99%

Outcomes After Carotid Artery Stenting and Endarterectomy in the Medicare Population

Wang

Esterbrooks

Kuo

et al. 2011

Stroke

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Background and Purpose-Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for stroke prevention. The value of this therapy relative to CEA remains uncertain. Methods-In 10 958 Medicare patients aged 66 years or older between 2004 and 2006, we analyzed in-hospital, 1-year stroke, myocardial infarction, and death rate outcomes and the effects of potential confounding variables. Results-CAS patients (87% were asymptomatic) had a higher baseline risk profile, including having a higher percentage of coronary and peripheral arterial disease, heart failure, and renal failure. In-hospital stroke rate (1.9% CAS versus 1.4% CEA; Pϭ0.14) and mortality (CAS 0.9% versus 0.6% CEA; Pϭ0.20) were similar. By 1 year, CAS patients had similar stroke rates (5.3% CAS versus 4.1% CEA; Pϭ0.12) but higher all-cause mortality rates (9.9% CAS versus 6.1% CEA; PϽ0.001). Using Cox multivariable models, there was a similar stroke risk (hazard ratio, 1.28; 95% CI, 0.90 -1.79) but CAS patients had a significantly higher mortality (HR, 1.32; 95% CI, 1.02-1.71). Sensitivity analyses suggested that unmeasured confounders could be responsible for the mortality difference. In multivariable analysis, stroke risk was highest in the patients symptomatic at the time of revascularization. Conclusions-CAS patients had a similar stroke risk but an increased mortality rate at 1 year compared with CEA patients, possibly related to the higher baseline risk profile in the CAS patient group.

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Section: Methodsmentioning

confidence: 99%

Outcomes After Carotid Artery Stenting and Endarterectomy in the Medicare Population

Wang

Esterbrooks

Kuo

et al. 2011

Stroke

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“…Low CEA volume itself is likely not an explanation for the operative results, however, because both hospitals in our study would be classified as "moderate volume" facilities (21 to 100 operations per year) based on an earlier classification scheme. 9 Previous studies have also found that black patients undergoing CEA have differing risk factor profiles compared to whites. A 10-year analysis of CEA results in a large urban hospital found that blacks had higher rates of hypertension, diabetes, and renal insufficiency compared to whites.…”

Section: Discussionmentioning

confidence: 99%

“…Matsen et al conducted a large review of 23 237 CEA operations over a 10-year period in Maryland. 9 In this large cohort, 7.2% of the operations were done in blacks. They found that blacks had a higher perioperative stroke rate, comprising 16.1% of the patients with postoperative stroke versus 7.3% of the patients without strokes (PϽ0.001).…”

mentioning

confidence: 96%

Higher Risk Factor Burden and Worse Outcomes in Urban Carotid Endarterectomy Patients

Madhavan

Santhakumar

Mehri-Basha

et al. 2008

Stroke

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Background and Purpose-Previous multicenter carotid endarterectomy (CEA) studies had screening criteria for patient comorbidities and very few blacks. We assessed the hypothesis that CEA results from two urban hospitals would approximate those of the previous multicenter trials. Methods-A retrospective chart review was completed at two urban hospitals for CEA procedures done in 2003 and 2004. Demographic information and past medical history was recorded. In hospital perioperative complications (stroke or myocardial infarction [MI]) were noted. We calculated an expected perioperative stroke rate based on trial figures and our proportion of symptomatic and asymptomatic patients. Results-Patients in our cohort had significantly higher rates of hypertension, diabetes, smoking, black race, and elderly status compared to previous trials. The expected perioperative stroke was 3.1%, and the observed stroke rate was 4.7% (Pϭ0.36). Observed rates of MI (6.7%, PϽ0.001)) and stroke or MI (11.3%, PϽ0.0001) were higher than expected based on the previous trials. The stroke or MI rate in black subjects was higher (15.4% versus 5.6%, Pϭ0.065) and this was significant at the hospital with lower CEA volume. Conclusions-In two urban hospitals, CEA results were significantly worse than previous trials. Patient selection is likely to play a role because our cohort had higher numbers of hypertensives, diabetics, smokers, blacks, and elderly patients. Clinicians need to carefully consider the risk/benefit ratio of CEA in urban patients because our study shows that these patients have a large number of medical comorbidities and worse outcomes after CEA. Key Words: carotid endarterectomy Ⅲ carotid stenosis Ⅲ blacks E xtracranial carotid stenosis accounts for 10% to 15% of ischemic strokes. Carotid endarterectomy (CEA) has been found to be useful for stroke prevention in select patients with either recent symptoms or patients who are asymptomatic. [1][2][3][4] Although several clinical trials have been performed to establish the efficacy of CEA, these studies have included relatively few blacks.Blacks have a differing vascular profile compared to whites. For example, they have increased frequency of hypertension, diabetes, and intracranial occlusive disease. 5,6 These factors could increase the perioperative complication rate for blacks undergoing CEA. 7 We sought to evaluate the results of CEA from two urban hospitals with a predominantly black population. The hypothesis was that the perioperative results would approximate those seen in the major multicenter trials. MethodsWe conducted a retrospective chart review of all CEA cases performed at two urban hospitals during the 2003 to 2004 time period. Data abstraction was done by two trained physicians, and information was collected pertaining to demographic information, past medical history, clinical symptoms before the CEA, degree of stenosis, in-hospital complications, use of postoperative neuroimaging, length of stay, and discharge status.For comparison purposes, we calculated an ex...

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“…Un score pré dictif de moins de 3 % de dé cè s et d'AVC aprè s endarté riectomie vient d'être calculé à partir d'une é tude de 6553 opé ré s aux É tatsUnis [105]. De nombreuses é quipes chirurgicales aux É tats-Unis ont une incidence d'AVCI infé rieure à 2 % chez l'opé ré symptomatique et à 0,5 % chez celui qui est asymptomatique, ce qui semble devenir un objectif exigeable pour une é quipe [106,107]. Tout cela souligne l'importance de l'AVCI dans le processus de dé cision chirurgicale et le choix des é quipes chirurgicales.…”

Section: Chirurgie Carotidienneunclassified

Épidémiologie des accidents vasculaires cérébraux périopératoires

Rozec

Cinotti

Teurnier

et al. 2014

Annales Françaises d'Anesthésie et de Réanimation

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Trends in the in-hospital stroke rate following carotid endarterectomy in California and Maryland

Cited by 55 publications

References 32 publications

Outcomes After Carotid Artery Stenting and Endarterectomy in the Medicare Population

Outcomes After Carotid Artery Stenting and Endarterectomy in the Medicare Population

Higher Risk Factor Burden and Worse Outcomes in Urban Carotid Endarterectomy Patients

Épidémiologie des accidents vasculaires cérébraux périopératoires

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