Upper Extremity Blood Pressure Difference in Patients Undergoing Carotid Revascularisation

Huibers, Anne; Hendrikse, Jeroen; Brown, Martin M.; Pegge, Sjoert; Arnold, M.; Moll, Frans L.; Kapelle, L.J.; Borst, Gert J. de

doi:10.1016/j.ejvs.2016.11.023

Cited by 13 publications

(17 citation statements)

References 17 publications

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“…Above 70 years, CAS incurred significantly higher rates of death/stroke. 56 Below 70 years, CAS had similar death/ stroke rates to CEA.…”

Section: Clinical Predictorsmentioning

confidence: 81%

“…32 Factors associated with new WMLs. Factors associated with new WMLs included (i) lower systolic BP; 32 (ii) diabetes; 32 (iii) hemispheric stroke at presentation; 32 (iv) left sided stenoses; 32 (v) plaque echolucency; 45 (vi) increasing age; 52 (vii) male sex; 52 (viii) type II/III aortic arch vs. type I arch; 56 (ix) > 60 angle between the common carotid artery (CCA) and internal carotid artery; 56 (x) CPDs; 32 and (xi) intraprocedural haemodynamic depression (HD). 43 Altinbas et al evaluated HD in 229 ICSS patients, 43 observing that HD (one or more of hypotension requiring treatment, bradycardia, or asystole) affected 12% (n ¼ 15/122) of CAS patients vs. nine of 107 CEA patients (8%).…”

Section: Local Complicationsmentioning

confidence: 99%

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Editor's Choice – Overview of Primary and Secondary Analyses From 20 Randomised Controlled Trials Comparing Carotid Artery Stenting With Carotid Endarterectomy

Batchelder

Saratzis

Naylor

2019

European Journal of Vascular and Endovascular Surgery

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This paper provides an overview of primary/secondary outcome data from 20 randomised controlled trials comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS) in symptomatic and asymptomatic patients, including meta-analyses for peri-operative risks and late ipsilateral stroke. Secondary analyses include (i) risk factors for stroke after CEA/CAS; (ii) the effect of peri-operative stroke or myocardial infarction on long term survival; (iii) non-stroke complications; (iv) the significance of new white matter lesions on late stroke and cognitive impairment; and (v) whether asymptomatic 70%e99% restenoses increase the risk of ipsilateral stroke after CEA and CAS. Objectives: The aim of this review was to carry out primary and secondary analyses of 20 randomised controlled trials (RCTs) comparing carotid endarterectomy (CEA) with carotid artery stenting (CAS). Methods: A systematic review and meta-analysis of data from 20 RCTs (126 publications) was carried out. Results: Compared with CEA, the 30 day death/stroke rate was significantly higher after CAS in seven RCTs involving 3467 asymptomatic patients (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.02e2.64) and in 10 RCTs involving 5797 symptomatic patients (OR 1.71, 95% CI 1.38e2.11). Excluding procedural risks, late ipsilateral stroke was about 4% at 9 years for both CEA and CAS, i.e., CAS was durable. Reducing procedural death/stroke after CAS may be achieved through better case selection, e.g., performing CEA in (i) symptomatic patients aged > 70 years; (ii) interventions within 14 days of symptom onset; and (iii) situations where stroke risk after CAS is predicted to be higher (segmental/remote plaques, plaque length > 13 mm, heavy burden of white matter lesions [WMLs], where two or more stents might be needed). New WMLs were significantly more common after CAS (52% vs. 17%) and were associated with higher rates of late stroke/transient ischaemic attack (23% vs. 9%), but there was no evidence that new WMLs predisposed towards late cognitive impairment. Restenoses were more common after CAS (10%) but did not increase late ipsilateral stroke. Restenoses (70%e99%) after CEA were associated with a small but significant increase in late ipsilateral stroke (OR 3.87, 95% CI 1.96e7.67; p < .001). Conclusions: CAS confers higher rates of 30 day death/stroke than CEA. After 30 days, ipsilateral stroke is virtually identical for CEA and CAS. Key issues to be resolved include the following: (i) Will newer stent technologies and improved cerebral protection allow CAS to be performed < 14 days after symptom onset with risks similar to CEA? (ii) What is the optimal volume of CAS procedures to maintain competency? (iii) How to deliver better risk factor control and best medical treatment? (iv) Is there a role for CEA/CAS in preventing/reversing cognitive impairment?

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“…Above 70 years, CAS incurred significantly higher rates of death/stroke. 56 Below 70 years, CAS had similar death/ stroke rates to CEA.…”

Section: Clinical Predictorsmentioning

confidence: 81%

Section: Local Complicationsmentioning

confidence: 99%

Editor's Choice – Overview of Primary and Secondary Analyses From 20 Randomised Controlled Trials Comparing Carotid Artery Stenting With Carotid Endarterectomy

Batchelder

Saratzis

Naylor

2019

European Journal of Vascular and Endovascular Surgery

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show abstract

“…We divided patients into four groups according to the IASBPD as; <10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg [16] . Furthermore, patients were divided into another two groups with respect to significant stenosis of the subclavian artery (≥ 50%) and the vertebral artery (≥ 50%) [17] .…”

Section: Methodsmentioning

confidence: 99%

“…Perioperative blood pressure disturbances are seen in 13-23% of patients undergoing carotid endarterectomy [13,18] . Thus, perioperative blood pressure measurement of both arms is essential to avoid mistaken blood pressure measurement, which may lead to perioperative stroke due to cerebral hyperperfusion syndrome in patients undergoing carotid endarterectomy [12,13,17,19,20] . The relation of subclavian artery stenosis and more than 20 mmHg of IASBPD is already well established with a recent meta-analysis conducted by Cao et al [2] , which supported this strong association (RR 8.8, 95% CI 3.6-21.2, P <0.01) and our findings were consistent with this previous study ( P =0.009).…”

Section: Di̇scussi̇onmentioning

confidence: 99%

“…[20] reported that the sensitivity and the specificity to detect the subclavian artery stenosis for more than 10 mmHg of IASBPD was 65% and 85% while, 20 mmHg of difference was 35% and 94%, respectively. Worthy of note, most of the previous studies considered a threshold value of 20 mmHg [17,19] thus we considered 20 mmHg of IASBPD as a threshhold value.…”

Section: Di̇scussi̇onmentioning

confidence: 99%

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Relationship of Inter-Arm Systolic Blood Pressure Difference with Subclavian Artery Stenosis and Vertebral Artery Stenosis in Patients Undergoing Carotid Endarterectomy

Deşer¹,

Yücel²,

Demirağ³

et al. 2019

Braz J Cardiovasc Surg

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Introduction The aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy. Methods A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ˂ 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%. Results Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis ( P =0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis ( P =0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis ( P =0.01). Conclusion Patients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.

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Preoperative hypertension is associated with atherosclerotic intraplaque hemorrhage in patients undergoing carotid endarterectomy

et al. 2019

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Upper Extremity Blood Pressure Difference in Patients Undergoing Carotid Revascularisation

Cited by 13 publications

References 17 publications

Editor's Choice – Overview of Primary and Secondary Analyses From 20 Randomised Controlled Trials Comparing Carotid Artery Stenting With Carotid Endarterectomy

Editor's Choice – Overview of Primary and Secondary Analyses From 20 Randomised Controlled Trials Comparing Carotid Artery Stenting With Carotid Endarterectomy

Relationship of Inter-Arm Systolic Blood Pressure Difference with Subclavian Artery Stenosis and Vertebral Artery Stenosis in Patients Undergoing Carotid Endarterectomy

Preoperative hypertension is associated with atherosclerotic intraplaque hemorrhage in patients undergoing carotid endarterectomy

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