Vascular Anatomy and Not Age is Responsible for Increased Risk of Complications in Symptomatic Elderly Patients Undergoing Carotid Artery Stenting

Fanous, Andrew A.; Jowdy, Patrick K.; Morr, Simon; Vakharia, Kunal; Shallwani, Hussain; Lőrincz, Katalin; Hopkins, L. Nelson; Davies, Jason M.; Snyder, Kenneth V.; Siddiqui, Adnan H.; Levy, Elad I.

doi:10.1016/j.wneu.2019.04.187

Cited by 10 publications

(12 citation statements)

References 53 publications

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“…Severe is defined when the angle is less than 90°, whereas moderate tortuosity when it is 90 and 120°. 2,3 In our case, both indexes were as follows: 162% for the right common carotid artery (RCCA), 134% for the right internal carotid artery (RICA), 154% for the left common carotid artery (LCCA), 141% for the left internal carotid artery (LICA), and 59° on RCCA, 72° and 79° degree on RICA, 49° and 43° on LCCA, and 33° on LICA. Tortuous LICA was also located very close to the pharyngeal mucosa (1.6 mm) ( Figure 3D), but this pathology was asymptomatic.…”

Section: Discussionmentioning

confidence: 57%

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Carotid artery tortuosity may pose a problem during insertion of the tunneled catheter for hemodialysis

et al. 2020

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Tortuosity of the carotid artery is usually an asymptomatic vascular abnormality and is discovered accidentally during cerebral angiography. These vascular changes may aggravate surgical procedures in the neck region. We described a technique of permanent catheter insertion in patients with renal graft failure in whom renal replacement therapy was necessary. Severe tortuosity of cervical arteries may make this procedure more difficult, necessitating a special technique, that is, full image monitoring.

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Section: Discussionmentioning

confidence: 57%

“…Tortuosity can be diagnosed if the angle is less than 120°. Severe is defined when the angle is less than 90°, whereas moderate tortuosity when it is 90 and 120° 2,3 …”

Section: Discussionmentioning

confidence: 99%

Carotid artery tortuosity may pose a problem during insertion of the tunneled catheter for hemodialysis

et al. 2020

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“…Further pooling various separate anatomic features into informal risk categories demonstrate significant association of 'high risk' anatomy with age over 80 years [12]. Although there appears to be increased risk of AIS in elderly patients undergoing CAS [78], univariate analysis of complication rates between anatomic risk categories while stratifying elderly (over 80 years of age) and younger patients undergoing CAS [79], making it difficult to define a causal relationship regarding arch variations. Illustratively, univariate studies regarding populations separated by age found no association with perioperative morbidity [79,80].…”

Section: Patient Agementioning

confidence: 99%

“…Although there appears to be increased risk of AIS in elderly patients undergoing CAS [78], univariate analysis of complication rates between anatomic risk categories while stratifying elderly (over 80 years of age) and younger patients undergoing CAS [79], making it difficult to define a causal relationship regarding arch variations. Illustratively, univariate studies regarding populations separated by age found no association with perioperative morbidity [79,80]. It is likely that while age increases risk of adverse anatomy, it is a confounding variable and the anatomy itself is a predictor to potential complications [79][80][81][82][83].…”

Section: Patient Agementioning

confidence: 99%

Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines

Scullen

Mathkour

Carr

et al. 2020

JCM

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Patient selection for endovascular intervention in extracranial carotid disease is centered on vascular anatomy. We review anatomical considerations for non-traumatic disease and offer guidelines in patient selection and management. We conducted a systematic literature review without meta-analysis for studies involving anatomical considerations in extracranial carotid intervention for non-traumatic disease. Anatomical considerations discussed included aortic arch variants, degree of vessel stenosis, angulation, tortuosity, and anomalous origins, and atheromatous plaque morphology, composition, and location. Available literature suggests that anatomical risks of morbidity are largely secondary to increased procedural times and difficulties in intervention system delivery. We recommend the prioritization of endovascular techniques on an individual basis in cases where accessible systems and surgeon familiarity provide an acceptable likelihood of rapid access and device deployment.

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“…Stroke is a leading cause of death worldwide and approximately 15% to 20% of ischemic strokes are caused by carotid artery stenosis. [ 1 , 2 ] Carotid endarterectomy (CEA) is the golden standard surgical therapy for atherosclerotic carotid artery stenosis. [ 1 ] On the contrary, carotid artery stenting (CAS), a less invasive intervention, has been shown by many clinical studies to be an effective alternative.…”

Section: Introductionmentioning

confidence: 99%

Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population

Bai

Feng

Wang

et al. 2020

Chinese Medical Journal

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Background Metabolic syndrome (MetS) is relatively common worldwide and an important risk factor for cardiovascular diseases. It is closely linked to arterial stiffness of the carotid artery. However, the association of MetS with the safety of carotid revascularization has been rarely studied. The aim of this study was to observe the current status of MetS and its components in Chinese carotid revascularized patients, and investigate the impact on major adverse clinical events (MACEs) after carotid endarterectomy (CEA) or carotid artery stenting (CAS). Methods From January 2013 to December 2017, patients undergoing CEA or CAS in the Neurosurgery Department of Xuanwu Hospital were retrospectively recruited. The changes in prevalence of MetS and each component with time were investigated. The primary outcome was 30-day post-operative MACEs. Univariable and multivariable analyses were performed to identify the impact of MetS on CEA or CAS. Results A total of 2068 patients who underwent CEA (766 cases) or CAS (1302 cases) were included. The rate of MetS was 17.9%; the prevalence rate of MetS increased with time. The occurrence rate of MACEs in CEA was 3.4% (26 cases) and in CAS, 3.1% (40 cases). There was no statistical difference between the two groups (3.4% vs . 3.1%, P = 0.600). For CEA patients, univariate analysis showed that the MACE (+) group had increased diabetes history (53.8% vs . 30.9%, P = 0.014) and MetS (34.6% vs . 15.8%, P = 0.023). For CAS patients, univariate analysis showed that the MACE (+) group had increased coronary artery disease history (40.0% vs . 21.6%, P = 0.006) and internal carotid artery tortuosity (67.5%% vs . 37.6%, P < 0.001). Furthermore, the MACE (+) group had higher systolic blood pressure (143.38 ± 22.74 vs . 135.42 ± 17.17 mmHg, P = 0.004). Multivariable analysis showed that the influencing factors for MACEs in CEA included history of diabetes (odds ratio [OR] = 2.345; 95% confidence interval [CI] = 1.057–5.205; P = 0.036) and MetS (OR = 2.476; 95% CI = 1.065–5.757; P = 0.035). The influencing factors for MACEs in CAS included systolic blood pressure (OR = 1.023; 95% CI = 1.005–1.040; P = 0.010), coronary artery disease (OR = 2.382; 95% CI = 1.237–4.587; P = 0.009) and internal carotid artery tortuosity (OR = 3.221; 95% CI = 1.637–6.337; P = 0.001). Conclusions The prevalence rate of MetS increased with time in carotid revascularized patients. MetS is a risk for short-term MACEs after CEA, but not CAS. ...

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Vascular Anatomy and Not Age is Responsible for Increased Risk of Complications in Symptomatic Elderly Patients Undergoing Carotid Artery Stenting

Cited by 10 publications

References 53 publications

Carotid artery tortuosity may pose a problem during insertion of the tunneled catheter for hemodialysis

Carotid artery tortuosity may pose a problem during insertion of the tunneled catheter for hemodialysis

Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines

Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population

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