Use of a primary carotid stenting technique does not affect perioperative outcomes.
J Vasc Surg
; 67(6): 1736-1743.e1, 2018 06.
Article
em En
| MEDLINE
| ID: mdl-29398315
ABSTRACT
BACKGROUND:
Primary carotid stenting (PCS) has been shown to be feasible and safe in small series, but real-world outcomes in a large multicenter data set have yet to be explored. We aimed to compare outcomes for PCS (PCS+) vs conventional carotid artery stenting (CAS) with angioplasty (PCS-) using a national database.METHODS:
We analyzed all CAS cases in the Vascular Quality Initiative (VQI) database (2005-2016) using univariable and multivariable logistic regression to assess the effect of PCS on outcomes. The primary end point was a composite of stroke/death occurring within 30 days.RESULTS:
The study included 10,074 patients (mean age, 69.5 ± 9.9 years; 64% male). The composite end point occurred in 3.5% of cases (stroke, 2.4%; death, 1.5%). PCS was used in 688 (6.8%) patients. On univariable analysis, stroke/death occurred more frequently with PCS+ vs PCS- (5.2% vs 3.4%; P = .01). However, this difference was mitigated after adjusting for baseline group differences (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.72-1.83; P = .55). PCS also had no significant effect on the primary composite end point on adjusted analysis stratified by symptom status (asymptomatic OR, 0.98 [95% CI, 0.39-2.48]; symptomatic OR, 1.19 [95% CI 0.66-2.06]) or among patients undergoing CAS with embolic protection (OR, 1.54 [95% CI, 0.92-2.57]). Patients undergoing CAS without embolic protection had a significantly higher risk of stroke/death regardless of the stenting technique used (OR, 3.97 [95% CI, 2.47-6.37]).CONCLUSIONS:
PCS is associated with a similar risk of stroke and death compared with conventional CAS with angioplasty. The use of an embolic protection device is essential to good outcomes with both techniques.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Procedimentos Cirúrgicos Vasculares
/
Stents
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Estenose das Carótidas
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article