ArticleJournal of vascular surgery2018
An update on the incidence of perioperative outcomes after carotid endarterectomy, stratified by type of preprocedural neurologic symptom.
Article in Journal of vascular surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
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
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- External Validation of Risk Prediction Models to Improve Selection of Patients for Carotid Endarterectomy.Stroke · 2022Pooled it
- Seven years of the transcarotid artery revascularization surveillance project, comparison to transfemoral stenting and endarterectomy.Journal of vascular surgery · 2024Article
- Article
- Outcomes after transcarotid artery revascularization stratified by preprocedural symptom status.Journal of vascular surgery · 2022Article
- Outcomes after transfemoral carotid artery stenting stratified by preprocedural symptom status.Journal of vascular surgery · 2021Article
- The conundrum of asymptomatic carotid stenosis-determinants of decision and evidence.Annals of translational medicine · 2020Review
- Risk of Stroke or Death Is Associated With the Timing of Carotid Artery Stenting for Symptomatic Carotid Stenosis: A Secondary Data Analysis of the German Statutory Quality Assurance Database.Journal of the American Heart Association · 2018Observational
- Perioperative stroke: pathophysiology and management.Korean journal of anesthesiology · 2018Review
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 3 countries.
Funding
Abstract
objectivePerioperative complications after carotid endarterectomy (CEA) have decreased over time. Therefore, we aimed to provide an update on 30-day outcomes after CEA, stratified by type of preprocedural neurologic symptom.
methodsWe included all CEAs from the Targeted Vascular module of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP, 2011-2015) and stratified patients based on type of preprocedural neurologic symptom, that is, asymptomatic, ocular transient ischemic attack (TIA), hemispheric TIA, and stroke. We compared 30-day outcomes across the groups, with 30-day stroke/death as our primary endpoint.
resultsOf 16,739 CEA patients, 9784 were asymptomatic (58%). Among the 6955 symptomatic patients, 1216 (17%) had a preprocedural ocular TIA, 2635 (38%) a preprocedural hemispheric TIA, and 3104 (45%) a preprocedural stroke. Preprocedural stroke patients had higher 30-day stroke/death rates compared with those with a preprocedural hemispheric TIA, or ocular TIA, or asymptomatic patients (5.0% vs 3.3%, 1.9%, and 1.8%, respectively; all P < .001), primarily owing to differences in perioperative 30-day stroke rates, with 4.1% vs 2.5%, 1.4%, and 1.3%, respectively (all P < .001).
conclusionsAmong symptomatic CEA patients, those with a preprocedural stroke had a high perioperative 30-day stroke/death rate, compared with those patients with either a preprocedural hemispheric or ocular TIA. Therefore, the common stratification applied to CEA patients, which groups all symptomatic patients, should be avoided, especially as the relative proportion of symptomatic patients with a preprocedural stroke vs those with a hemispheric or ocular TIA will affect the overall outcome for all symptomatic patients after CEA.
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