TY - JOUR
T1 - Carotid artery stenting of a contralateral occlusion and in-hospital outcomes
T2 - Results from the CARE (Carotid Artery Revascularization and Endarterectomy) registry
AU - Mercado, Nestor
AU - Cohen, David J.
AU - Spertus, John A.
AU - Chan, Paul S.
AU - House, John
AU - Kennedy, Kevin
AU - Brindis, Ralph G.
AU - White, Christopher J.
AU - Rosenfield, Kenneth A.
AU - Marso, Steven P.
N1 - Funding Information:
The CARE Registry is an initiative of the American College of Cardiology Foundation, the Society for Cardiovascular Angiography and Interventions, the Society of Interventional Radiology, the American Academy of Neurology, the American Association of Neurological Surgeons/Congress of Neurological Surgeons, the Society for Vascular Medicine, and the Society of Vascular and Interventional Neurology. Dr. Cohen receives consulting income from Medtronic and Abbott Vascular; and research grant support from Medtronic , Abbott Vascular , Boston Scientific , and St. Jude Medical . Dr. Spertus has a contract with the American College of Cardiology Foundation for the analysis of the CARE Registry. Dr. Rosenfield is a consultant for and receives research support from Abbott; and receives royalties from Cordis for the Angioguard RX Guidewire System. All compensation for Dr. Marso's research activities, including research grants and consulting fees from the Medicines Company , Novo Nordisk , Abbott Vascular , Amylin Pharmaceuticals , Boston Scientific , Volcano Corporation , and Terumo Medical , are paid directly to the Saint Luke's Hospital Foundation of Kansas City. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. William Gray, MD, served as Guest Editor of this paper.
PY - 2013/1
Y1 - 2013/1
N2 - Objectives: The authors sought to study the characteristics and outcomes of patients with contralateral carotid artery occlusions (CCOs) undergoing elective carotid artery stenting (CAS). Background: CCOs are associated with adverse neurological events following carotid endarterectomy. Methods: In-hospital outcomes were examined in patients with and without CCO undergoing elective CAS in the Carotid Artery Revascularization and Endarterectomy (CARE) registry. A CCO was defined as a 100% occlusion of the contralateral internal carotid artery. To minimize differences in measured comorbidities, a 3:1 propensity matching analysis was performed comparing 42 clinical and demographic variables between CCO and non-CCO patients from the CARE registry. The primary endpoint was a composite of in-hospital death, nonfatal myocardial infarction, and nonfatal stroke. Results: Between April 2005 and January 2012, 13,993 eligible patients underwent elective CAS, of whom 1,450 (10%) had CCO. There were 5,500 CAS procedures (1,375 CCO and 4,125 non-CCO) identified in the propensity analysis. The primary composite endpoint occurred in 29 (2.1%) and 107 (2.6%) patients with and without CCO, respectively (adjusted odds ratio: 0.81, 95% confidence interval: 0.53 to 1.23, p = 0.316). Conclusions: In the CARE registry, there was no evidence that the presence of a CCO was associated with an increased risk of in-hospital death, nonfatal myocardial infarction, or nonfatal stroke in patients undergoing elective CAS. These findings may have implications on the selection of carotid revascularization procedures for such patients.
AB - Objectives: The authors sought to study the characteristics and outcomes of patients with contralateral carotid artery occlusions (CCOs) undergoing elective carotid artery stenting (CAS). Background: CCOs are associated with adverse neurological events following carotid endarterectomy. Methods: In-hospital outcomes were examined in patients with and without CCO undergoing elective CAS in the Carotid Artery Revascularization and Endarterectomy (CARE) registry. A CCO was defined as a 100% occlusion of the contralateral internal carotid artery. To minimize differences in measured comorbidities, a 3:1 propensity matching analysis was performed comparing 42 clinical and demographic variables between CCO and non-CCO patients from the CARE registry. The primary endpoint was a composite of in-hospital death, nonfatal myocardial infarction, and nonfatal stroke. Results: Between April 2005 and January 2012, 13,993 eligible patients underwent elective CAS, of whom 1,450 (10%) had CCO. There were 5,500 CAS procedures (1,375 CCO and 4,125 non-CCO) identified in the propensity analysis. The primary composite endpoint occurred in 29 (2.1%) and 107 (2.6%) patients with and without CCO, respectively (adjusted odds ratio: 0.81, 95% confidence interval: 0.53 to 1.23, p = 0.316). Conclusions: In the CARE registry, there was no evidence that the presence of a CCO was associated with an increased risk of in-hospital death, nonfatal myocardial infarction, or nonfatal stroke in patients undergoing elective CAS. These findings may have implications on the selection of carotid revascularization procedures for such patients.
KW - myocardial infarction
KW - revascularization
KW - stenting
KW - stroke
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U2 - 10.1016/j.jcin.2012.09.009
DO - 10.1016/j.jcin.2012.09.009
M3 - Article
C2 - 23347862
AN - SCOPUS:84872779913
SN - 1936-8798
VL - 6
SP - 59
EP - 64
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 1
ER -