Paola De Rango1, Martin M Brown2, Seemant Chaturvedi2, Virginia J Howard2, Tudor Jovin2, Michael V Mazya2, Maurizio Paciaroni2, Alessandra Manzone2, Luca Farchioni2, Valeria Caso2. 1. From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.). plderango@gmail.com. 2. From the Unit of Vascular and Endovascular Surgery, Department of Surgical and Biomedical Sciences (P.D.R., A.M., L.F.) and Stroke Unit, Division of Cardiovascular Medicine (M.P., V.C.), Hospital S.M. Misericordia, Perugia, Italy; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom (M.M.B.); Department of Neurology and Stroke Program, University of Miami Miller School of Medicine, FL (S.C.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Stroke Institute and Department of Neurology, UPMC Center for Neuroendovascular Therapy, University of Pittsburgh Medical Center, PA (T.J.); and Department of Neurology, Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M.).
Abstract
BACKGROUND AND PURPOSE: This study aimed to assess the evidence on the periprocedural (<30 days) risks of carotid intervention in relation to timing of procedure in patients with recently symptomatic carotid stenosis. METHODS: A systematic literature review of studies published in the past 8 years reporting periprocedural stroke/death after carotid endarterectomy (CEA) and carotid stenting (CAS) related to the time between qualifying neurological symptoms and intervention was performed. Pooled estimates of periprocedural risk for patients treated within 0 to 48 hours, 0 to 7 days, and 0 to 15 days were derived with proportional meta-analyses and reported separately for patients with stroke and transient ischemic attack as index events. RESULTS: Of 47 studies included, 35 were on CEA, 7 on CAS, and 5 included both procedures. The pooled risk of periprocedural stroke was 3.4% (95% confidence interval [CI], 2.6-4.3) after CEA and 4.8% (95% CI, 2.5-7.8) after CAS performed <15 days; stroke/death rates were 3.8% and 6.9% after CEA and CAS, respectively. Pooled periprocedural stroke risk was 3.3% (95% CI, 2.1-4.6) after CEA and 4.8% (95% CI, 2.5-7.8) after CAS when performed within 0 to 7 days. In hyperacute surgery (<48 hours), periprocedural stroke risk after CEA was 5.3% (95% CI, 2.8-8.4) but with relevant risk differences among patients treated after transient ischemic attack (2.7%; 95% CI, 0.5-6.9) or stroke (8.0%; 95% CI, 4.6-12.2) as index. CONCLUSIONS: CEA within 15 days from stroke/transient ischemic attack can be performed with periprocedural stroke risk <3.5%. CAS within the same period may carry a stroke risk of 4.8%. Similar periprocedural risks occur after CEA and CAS performed earlier, within 0 to 7 days. Carotid revascularization can be safely performed within the first week (0-7 days) after symptom onset.
BACKGROUND AND PURPOSE: This study aimed to assess the evidence on the periprocedural (<30 days) risks of carotid intervention in relation to timing of procedure in patients with recently symptomatic carotid stenosis. METHODS: A systematic literature review of studies published in the past 8 years reporting periprocedural stroke/death after carotid endarterectomy (CEA) and carotid stenting (CAS) related to the time between qualifying neurological symptoms and intervention was performed. Pooled estimates of periprocedural risk for patients treated within 0 to 48 hours, 0 to 7 days, and 0 to 15 days were derived with proportional meta-analyses and reported separately for patients with stroke and transient ischemic attack as index events. RESULTS: Of 47 studies included, 35 were on CEA, 7 on CAS, and 5 included both procedures. The pooled risk of periprocedural stroke was 3.4% (95% confidence interval [CI], 2.6-4.3) after CEA and 4.8% (95% CI, 2.5-7.8) after CAS performed <15 days; stroke/death rates were 3.8% and 6.9% after CEA and CAS, respectively. Pooled periprocedural stroke risk was 3.3% (95% CI, 2.1-4.6) after CEA and 4.8% (95% CI, 2.5-7.8) after CAS when performed within 0 to 7 days. In hyperacute surgery (<48 hours), periprocedural stroke risk after CEA was 5.3% (95% CI, 2.8-8.4) but with relevant risk differences among patients treated after transient ischemic attack (2.7%; 95% CI, 0.5-6.9) or stroke (8.0%; 95% CI, 4.6-12.2) as index. CONCLUSIONS: CEA within 15 days from stroke/transient ischemic attack can be performed with periprocedural stroke risk <3.5%. CAS within the same period may carry a stroke risk of 4.8%. Similar periprocedural risks occur after CEA and CAS performed earlier, within 0 to 7 days. Carotid revascularization can be safely performed within the first week (0-7 days) after symptom onset.
Authors: Joe L P Kolkert; Rolf H H Groenwold; Vanessa J Leijdekkers; Joep Ter Haar; Clark J Zeebregts; Anco Vahl Journal: World J Surg Date: 2017-11 Impact factor: 3.352
Authors: Adnan I Qureshi; Samiat Agunbiade; Wei Huang; Iqra N Akhtar; Michael G Abraham; Naveed Akhtar; Fawaz Al-Mufti; Emrah Aytac; Ferhat Balgetir; Mikayel Grigoryan; Camilo R Gomez; Ameer E Hassan; Vishal Jani; Nazli A Janjua; Liqun Jiao; Rakesh Khatri; Jawad F Kirmani; Adam Kobayashi; Osman Kozak; Jun Lee; Iryna Lobanova; Ossama Yassin Mansour; Alberto Maud; Mikael Mazighi; Michel Piotin; Gustavo J Rodriguez; Farhan Siddiq; M Fareed K Suri; Wondwossen G Tekle Journal: J Neuroimaging Date: 2020-11-23 Impact factor: 2.324