Outcomes after early and delayed carotid endarterectomy in patients with symptomatic carotid artery stenosis

Ying Huang, Peter Gloviczki, Audra A. Duncan, Manju Kalra, Gustavo Oderich, Randall R De Martino, William S. Harmsen, Thomas C. Bower

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Abstract

Objective: The objective of this study was to define outcomes after carotid endarterectomy (CEA) in patients with symptomatic carotid artery stenosis (CAS) when patients are operated on within 14 days after onset of symptoms. Methods: Clinical data of consecutive patients who underwent CEA between 2003 and 2012 for symptomatic CAS were reviewed. Patients were classified into group 1, CEA ≤14 days of minor stroke or transient ischemic attack, and group 2, CEA >14 days. Primary end point was stroke/death; secondary end points were stroke, death, and myocardial infarction. Results: There were 233 patients (32% female; mean age, 72 ± 9.1 years) who underwent 238 CEAs. Group 1 included 57 CEAs in 56 patients; 11 CEAs were performed at 0 to 2 days, 23 at 3 to 7 days, and 23 at 8 to 14 days. Group 2 included 181 CEAs in 177 patients. One death (group 2) and five strokes (group 1, four; group 2, one) occurred at 30 days (stroke/death, 2.6%), more in group 1 vs group 2 (7.1% vs 1.1%; P =.03). In group 1, three strokes occurred when the patients were operated on within 2 days (27% [3/11]), more than at 3 to 7 days (0% [0/22]) or 8 to 14 days (4.3% [1/23]; P =.008). Patients operated on between days 3 and 14 had similar stroke/death rate to those operated on after 14 days (2.2% vs 1.1%; P =.49). Myocardial infarction occurred in six patients (2.5%; group 1, 0% [0/57]; group 2, 3.3% [6/177]; P =.34). Median follow-up was 7.0 years (interquartile range, 4.6-9.9 years). Freedoms from stroke/death were similar between groups (hazard ratio [HR], 1.22; 95% confidence interval [CI], 0.75-1.99; P =.42), 69% for group 1 and 76% for group 2 at 5 years. Age ≥80 years, high surgical risk, and no preoperative P2Y12 antagonist use predicted stroke/death. Freedoms from any stroke were similar in groups (HR, 2.46; 95% CI, 0.95-6.41; P =.06); survivals were also similar (HR, 1.12; 95% CI, 0.67-1.87; P =.67) at 5 years. Conclusions: In this single-center study, CEA in symptomatic patients had a 30-day stroke/death rate of 2.6%. Age ≥80 years and high surgical risk predicted late stroke or death; taking P2Y12 antagonists was associated with late stroke. High stroke rates when patients were operated on immediately support CEA after 2 days in symptomatic patients with CAS.

Original languageEnglish (US)
Pages (from-to)1110-1119.e1
JournalJournal of Vascular Surgery
Volume67
Issue number4
DOIs
StatePublished - Apr 1 2018

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Carotid Endarterectomy
Carotid Stenosis
Stroke
Confidence Intervals
Myocardial Infarction
Mortality
Transient Ischemic Attack

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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Outcomes after early and delayed carotid endarterectomy in patients with symptomatic carotid artery stenosis. / Huang, Ying; Gloviczki, Peter; Duncan, Audra A.; Kalra, Manju; Oderich, Gustavo; De Martino, Randall R; Harmsen, William S.; Bower, Thomas C.

In: Journal of Vascular Surgery, Vol. 67, No. 4, 01.04.2018, p. 1110-1119.e1.

Research output: Contribution to journalArticle

Huang, Ying ; Gloviczki, Peter ; Duncan, Audra A. ; Kalra, Manju ; Oderich, Gustavo ; De Martino, Randall R ; Harmsen, William S. ; Bower, Thomas C. / Outcomes after early and delayed carotid endarterectomy in patients with symptomatic carotid artery stenosis. In: Journal of Vascular Surgery. 2018 ; Vol. 67, No. 4. pp. 1110-1119.e1.
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abstract = "Objective: The objective of this study was to define outcomes after carotid endarterectomy (CEA) in patients with symptomatic carotid artery stenosis (CAS) when patients are operated on within 14 days after onset of symptoms. Methods: Clinical data of consecutive patients who underwent CEA between 2003 and 2012 for symptomatic CAS were reviewed. Patients were classified into group 1, CEA ≤14 days of minor stroke or transient ischemic attack, and group 2, CEA >14 days. Primary end point was stroke/death; secondary end points were stroke, death, and myocardial infarction. Results: There were 233 patients (32{\%} female; mean age, 72 ± 9.1 years) who underwent 238 CEAs. Group 1 included 57 CEAs in 56 patients; 11 CEAs were performed at 0 to 2 days, 23 at 3 to 7 days, and 23 at 8 to 14 days. Group 2 included 181 CEAs in 177 patients. One death (group 2) and five strokes (group 1, four; group 2, one) occurred at 30 days (stroke/death, 2.6{\%}), more in group 1 vs group 2 (7.1{\%} vs 1.1{\%}; P =.03). In group 1, three strokes occurred when the patients were operated on within 2 days (27{\%} [3/11]), more than at 3 to 7 days (0{\%} [0/22]) or 8 to 14 days (4.3{\%} [1/23]; P =.008). Patients operated on between days 3 and 14 had similar stroke/death rate to those operated on after 14 days (2.2{\%} vs 1.1{\%}; P =.49). Myocardial infarction occurred in six patients (2.5{\%}; group 1, 0{\%} [0/57]; group 2, 3.3{\%} [6/177]; P =.34). Median follow-up was 7.0 years (interquartile range, 4.6-9.9 years). Freedoms from stroke/death were similar between groups (hazard ratio [HR], 1.22; 95{\%} confidence interval [CI], 0.75-1.99; P =.42), 69{\%} for group 1 and 76{\%} for group 2 at 5 years. Age ≥80 years, high surgical risk, and no preoperative P2Y12 antagonist use predicted stroke/death. Freedoms from any stroke were similar in groups (HR, 2.46; 95{\%} CI, 0.95-6.41; P =.06); survivals were also similar (HR, 1.12; 95{\%} CI, 0.67-1.87; P =.67) at 5 years. Conclusions: In this single-center study, CEA in symptomatic patients had a 30-day stroke/death rate of 2.6{\%}. Age ≥80 years and high surgical risk predicted late stroke or death; taking P2Y12 antagonists was associated with late stroke. High stroke rates when patients were operated on immediately support CEA after 2 days in symptomatic patients with CAS.",
author = "Ying Huang and Peter Gloviczki and Duncan, {Audra A.} and Manju Kalra and Gustavo Oderich and {De Martino}, {Randall R} and Harmsen, {William S.} and Bower, {Thomas C.}",
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T1 - Outcomes after early and delayed carotid endarterectomy in patients with symptomatic carotid artery stenosis

AU - Huang, Ying

AU - Gloviczki, Peter

AU - Duncan, Audra A.

AU - Kalra, Manju

AU - Oderich, Gustavo

AU - De Martino, Randall R

AU - Harmsen, William S.

AU - Bower, Thomas C.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Objective: The objective of this study was to define outcomes after carotid endarterectomy (CEA) in patients with symptomatic carotid artery stenosis (CAS) when patients are operated on within 14 days after onset of symptoms. Methods: Clinical data of consecutive patients who underwent CEA between 2003 and 2012 for symptomatic CAS were reviewed. Patients were classified into group 1, CEA ≤14 days of minor stroke or transient ischemic attack, and group 2, CEA >14 days. Primary end point was stroke/death; secondary end points were stroke, death, and myocardial infarction. Results: There were 233 patients (32% female; mean age, 72 ± 9.1 years) who underwent 238 CEAs. Group 1 included 57 CEAs in 56 patients; 11 CEAs were performed at 0 to 2 days, 23 at 3 to 7 days, and 23 at 8 to 14 days. Group 2 included 181 CEAs in 177 patients. One death (group 2) and five strokes (group 1, four; group 2, one) occurred at 30 days (stroke/death, 2.6%), more in group 1 vs group 2 (7.1% vs 1.1%; P =.03). In group 1, three strokes occurred when the patients were operated on within 2 days (27% [3/11]), more than at 3 to 7 days (0% [0/22]) or 8 to 14 days (4.3% [1/23]; P =.008). Patients operated on between days 3 and 14 had similar stroke/death rate to those operated on after 14 days (2.2% vs 1.1%; P =.49). Myocardial infarction occurred in six patients (2.5%; group 1, 0% [0/57]; group 2, 3.3% [6/177]; P =.34). Median follow-up was 7.0 years (interquartile range, 4.6-9.9 years). Freedoms from stroke/death were similar between groups (hazard ratio [HR], 1.22; 95% confidence interval [CI], 0.75-1.99; P =.42), 69% for group 1 and 76% for group 2 at 5 years. Age ≥80 years, high surgical risk, and no preoperative P2Y12 antagonist use predicted stroke/death. Freedoms from any stroke were similar in groups (HR, 2.46; 95% CI, 0.95-6.41; P =.06); survivals were also similar (HR, 1.12; 95% CI, 0.67-1.87; P =.67) at 5 years. Conclusions: In this single-center study, CEA in symptomatic patients had a 30-day stroke/death rate of 2.6%. Age ≥80 years and high surgical risk predicted late stroke or death; taking P2Y12 antagonists was associated with late stroke. High stroke rates when patients were operated on immediately support CEA after 2 days in symptomatic patients with CAS.

AB - Objective: The objective of this study was to define outcomes after carotid endarterectomy (CEA) in patients with symptomatic carotid artery stenosis (CAS) when patients are operated on within 14 days after onset of symptoms. Methods: Clinical data of consecutive patients who underwent CEA between 2003 and 2012 for symptomatic CAS were reviewed. Patients were classified into group 1, CEA ≤14 days of minor stroke or transient ischemic attack, and group 2, CEA >14 days. Primary end point was stroke/death; secondary end points were stroke, death, and myocardial infarction. Results: There were 233 patients (32% female; mean age, 72 ± 9.1 years) who underwent 238 CEAs. Group 1 included 57 CEAs in 56 patients; 11 CEAs were performed at 0 to 2 days, 23 at 3 to 7 days, and 23 at 8 to 14 days. Group 2 included 181 CEAs in 177 patients. One death (group 2) and five strokes (group 1, four; group 2, one) occurred at 30 days (stroke/death, 2.6%), more in group 1 vs group 2 (7.1% vs 1.1%; P =.03). In group 1, three strokes occurred when the patients were operated on within 2 days (27% [3/11]), more than at 3 to 7 days (0% [0/22]) or 8 to 14 days (4.3% [1/23]; P =.008). Patients operated on between days 3 and 14 had similar stroke/death rate to those operated on after 14 days (2.2% vs 1.1%; P =.49). Myocardial infarction occurred in six patients (2.5%; group 1, 0% [0/57]; group 2, 3.3% [6/177]; P =.34). Median follow-up was 7.0 years (interquartile range, 4.6-9.9 years). Freedoms from stroke/death were similar between groups (hazard ratio [HR], 1.22; 95% confidence interval [CI], 0.75-1.99; P =.42), 69% for group 1 and 76% for group 2 at 5 years. Age ≥80 years, high surgical risk, and no preoperative P2Y12 antagonist use predicted stroke/death. Freedoms from any stroke were similar in groups (HR, 2.46; 95% CI, 0.95-6.41; P =.06); survivals were also similar (HR, 1.12; 95% CI, 0.67-1.87; P =.67) at 5 years. Conclusions: In this single-center study, CEA in symptomatic patients had a 30-day stroke/death rate of 2.6%. Age ≥80 years and high surgical risk predicted late stroke or death; taking P2Y12 antagonists was associated with late stroke. High stroke rates when patients were operated on immediately support CEA after 2 days in symptomatic patients with CAS.

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