Trial reportEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery2017
Diastolic Blood Pressure is a Risk Factor for Peri-procedural Stroke Following Carotid Endarterectomy in Asymptomatic Patients.
Trial report in European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Influences of age and gender on operative risks following carotid endarterectomy: A systematic review and meta-analysis.PloS one · 2023Pooled it
- Meta-analysis of the procedural risks of carotid endarterectomy and carotid artery stenting over time.The British journal of surgery · 2018Pooled it
- Redefining postoperative hypertension management in carotid surgery: a comprehensive analysis of blood pressure homeostasis and hyperperfusion syndrome in unilateral vs. bilateral carotid surgeries and implications for clinical practice.Frontiers in surgery · 2024Article
- Optimal systolic and diastolic blood pressure threshold that associated with lower risk of white matter hyperintensity progression.Frontiers in aging neuroscience · 2023Article
- Predictive value of free fatty acid levels in embolic stroke of undetermined source: A retrospective observational study.Medicine · 2020Observational
- Prediction for cardiovascular diseases based on laboratory data: An analysis of random forest model.Journal of clinical laboratory analysis · 2020Article
- Article
- Perioperative Stroke.Current neurology and neuroscience reports · 2020Review
- Risk Factors for Intestinal Barrier Impairment in Patients With Essential Hypertension.Frontiers in medicine · 2020Article
- Risk Factors of Cerebral Infarction and Myocardial Infarction after Carotid Endarterectomy Analyzed by Machine Learning.Computational and mathematical methods in medicine · 2020Article
- Update in the Evaluation and Management of Perioperative Stroke.Current treatment options in cardiovascular medicine · 2019Review
- Effects of patient age on outcomes after carotid endarterectomy: A retrospective, single-center study in Korea.Medicine · 2019Observational
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
OBJECTIVE/
backgroundCarotid endarterectomy (CEA) prevents future stroke, but this benefit depends on detection and control of high peri-operative risk factors. In symptomatic patients, diastolic hypertension has been causally related to procedural stroke following CEA. The aim was to identify risk factors causing peri-procedural stroke in asymptomatic patients and to relate these to timing of surgery and mechanism of stroke.
methodsIn the first Asymptomatic Carotid Surgery Trial (ACST-1), 3,120 patients with severe asymptomatic carotid stenosis were randomly assigned to CEA plus medical therapy or to medical therapy alone. In 1,425 patients having their allocated surgery, baseline patient characteristics were analysed to identify factors associated with peri-procedural (< 30 days) stroke or death. Multivariate analysis was performed on risk factors with a p value < .3 from univariate analysis. Event timing and mechanism of stroke were analysed using chi-square tests.
resultsA total of 36 strokes (27 ischaemic, four haemorrhagic, five unknown type) and six other deaths occurred during the peri-procedural period, resulting in a stroke/death rate of 2.9% (42/1,425). Diastolic blood pressure at randomisation was the only significant risk factor in univariate analysis (odds ratio [OR] 1.34 per 10 mmHg, 95% confidence interval [CI] 1.04-1.72; p = .02) and this remained so in multivariate analysis when corrected for sex, age, lipid lowering therapy, and prior infarcts or symptoms (OR 1.34, 95% CI 1.05-1.72; p = .02). In patients with diastolic hypertension (> 90 mmHg) most strokes occurred during the procedure (67% vs. 20%; p = .02).
conclusionIn ACST-1, diastolic blood pressure was the only independent risk factor associated with peri-procedural stroke or death. While the underlying mechanisms of the association between lower diastolic blood pressure and peri-procedural risk remain unclear, good pre-operative control of blood pressure may improve procedural outcome of carotid surgery in asymptomatic patients.
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