Age, stenosis severity predict outcomes in emergency carotid revascularization
Age and stenosis severity were among the factors predicting stroke or death in patients undergoing emergency carotid revascularization, researchers reported.
The researchers analyzed 5,058 patients (mean age, 70 years; 68% men) who underwent emergency carotid revascularization via percutaneous transluminal angioplasty with carotid artery stenting (n = 1,882) or carotid endarterectomy (n = 3,176) in Germany between 2009 and 2014.
The primary outcome was new stroke or all-cause death before hospital discharge. The researchers performed multilevel multivariable regression analyses to determine predictors of outcomes.
The primary outcome occurred in 9% of patients who underwent surgery and 11.7% of patients who underwent CAS, Christoph Knappich, MD, from the department of vascular and endovascular surgery at Klinikum rechts der Isar, Technical University of Munich, and colleagues wrote.
Predictors of stroke or death after emergency carotid endarterectomy included age (RR per 10-year increase = 1.3; 95% CI, 1.12-1.5), American Society of Anesthesiologists Class (RR for class 4/5 vs. class 3 = 2.34; 95% CI, 1.65-3.32), ipsilateral degree of stenosis (RR for occlusion vs. severe stenosis = 1.9; 95% CI, 1.29-2.79; RR for ipsilateral low-grade stenosis vs. severe carotid stenosis = 3.06; 95% CI, 1.55-6.02) and neurologic deficit upon admission (RR for modified Rankin Scale score of 3 to 5 vs. 0 to 2 = 1.48; 95% CI, 1.04-2.1), according to the researchers.
Predictors of stroke or death after emergency CAS included age (RR per 10-year increase = 1.58; 95% CI, 1.37-1.82), American Society of Anesthesiologists Class (RR for class 1/2 vs. class 3 = 0.66; 95% CI, 0.46-0.95; RR for class 4/5 vs. class 3 = 1.91; 95% CI, 1.31-2.78) and ipsilateral degree of stenosis (RR for moderate vs. severe stenosis = 0.19; 95% CI, 0.04-0.77; RR for occlusion vs. severe stenosis = 1.63; 95% CI, 1.18-2.25), they wrote.
“Data collection for this study was prospective, nationwide, unselected and compulsory by law, and therefore the data set of treated patients is almost complete. Consequently, this study represents the real-world practice in Germany from 2009 to 2014,” Knappich and colleagues wrote. “These data could be used as a basis for confirmatory trials in the future.” – by Erik Swain
Disclosure: The authors report no relevant financial disclosures.