Document Detail


Carotid revascularization immediately before urgent cardiac surgery practice patterns associated with the choice of carotid artery stenting or endarterectomy: a report from the CARE (Carotid Artery Revascularization and Endarterectomy) registry.
MedLine Citation:
PMID:  22115660     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We describe characteristics associated with use of endarterectomy (CEA) versus stenting (CAS) in patients before urgent cardiac surgery.
BACKGROUND: The optimal modality of carotid revascularization preceding cardiac surgery is unknown.
METHODS: Retrospective evaluation of the CARE (Carotid Artery Revascularization and Endarterectomy) registry from January 2005 to April 2010 was performed on patients undergoing CEA or CAS preceding urgent cardiac surgery within 30 days. Baseline characteristics were compared, and multivariate adjustment was performed.
RESULTS: Of 451 patients who met study criteria, 255 underwent CAS and 196 underwent CEA. Both procedures increased over time to a similar degree (p = 0.18). Patients undergoing CAS had more frequent history of peripheral artery disease (38.2% vs. 26.5%, p < 0.01), neck surgery (5.5% vs. 1.0%, p = 0.01), neck radiation (4.3% vs. 1.0%, p = 0.04), left-main coronary disease (34.8% vs. 23.5%, p < 0.01), neurological events (45.8% vs. 31.3%, p < 0.01), carotid intervention (20.8% vs. 7.6%, p < 0.01), and higher baseline creatinine (1.3 vs. 1.1 mg/dl, p = 0.02). The target carotid arteries of CAS patients were more likely to be symptomatic in the 6 months before revascularization and have restenosis from prior CEA. Patients undergoing CAS had a lower American Society of Anesthesiology grade. Midwest hospitals were less likely to perform CAS than CEA, whereas in the other regions CAS was more common (p < 0.01). Non-Caucasian race, a history of heart failure, previous carotid procedures, prior stroke, left main coronary artery stenosis, lower American Society of Anesthesiology grade, and teaching hospital were independent predictors of patients who would receive CAS.
CONCLUSIONS: Carotid artery stenting and CEA have increased among patients undergoing urgent cardiac surgery. Patients who underwent CAS had more vascular disease but lower acute pre-surgical risk. Significant regional variation in procedure selection exists.
Authors:
Creighton W Don; John House; Christopher White; Thomas Kiernan; Mary Weideman; Nicholas Ruggiero; Andrew McCann; Kenneth Rosenfield
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  4     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-25     Completed Date:  2012-03-25     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1200-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty / adverse effects,  instrumentation*
Cardiac Surgical Procedures*
Carotid Artery Diseases / complications,  diagnosis,  surgery,  therapy*
Endarterectomy, Carotid* / adverse effects
Female
Healthcare Disparities
Heart Diseases / complications,  diagnosis,  surgery*
Humans
Logistic Models
Male
Middle Aged
Patient Selection
Physician's Practice Patterns*
Registries
Residence Characteristics
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Stents*
Time Factors
Treatment Outcome
United States
Grant Support
ID/Acronym/Agency:
5 KL2 RR025015/RR/NCRR NIH HHS; KL2 RR025015/RR/NCRR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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