scholarly journals PVSS17. The Impact of Centers for Medicaid & Medicare Services (CMS) High-Risk (HR) Criteria on Outcome after Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) in the SVS Vascular Registry (VR)

2012 ◽  
Vol 55 (6) ◽  
pp. 12S
Author(s):  
Marc L. Schermerhorn ◽  
Philip P. Goodney ◽  
Ellen D. Dillavou ◽  
Jeffrey Jim ◽  
Christopher T. Kenwood ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
The Impact

scholarly journals The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry

2013 ◽  
Vol 57 (5) ◽  
pp. 1318-1324 ◽  
Author(s):  
Marc L. Schermerhorn ◽  
Margriet Fokkema ◽  
Philip Goodney ◽  
Ellen D. Dillavou ◽  
Jeffrey Jim ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Risk Criteria ◽  
The Impact

Carotid Artery Stenting in Patients with High-Risk Anatomy for Carotid Endarterectomy

2001 ◽  
Vol 8 (1) ◽  
pp. 39-43 ◽  
Author(s):  
George Dangas ◽  
John R. Laird ◽  
Roxana Mehran ◽  
Lowell F. Satler ◽  
Alexandra J. Lansky ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting

scholarly journals Clinical trial of carotid artery stenting using dual-layer CASPER stent for carotid endarterectomy in patients at high and normal risk in the Japanese population

2020 ◽  
pp. neurintsurg-2020-016250
Author(s):  
Hirotoshi Imamura ◽  
Nobuyuki Sakai ◽  
Yasushi Matsumoto ◽  
Hiroshi Yamagami ◽  
Tomoaki Terada ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Peak Systolic Velocity ◽  
Cerebrovascular Event ◽  
Performance Goal ◽  
Significant Difference ◽  
Event Rates

BackgroundThe dual-layer nitinol CASPER stent was designed to prevent plaque prolapse into its strut and periprocedural stroke.ObjectiveTo conduct a clinical trial for government approval of the device in patients at either high or normal risk for carotid endarterectomy (CEA).MethodsEligible patients had ≥50% symptomatic stenosis or ≥80% asymptomatic stenosis according to the North American Symptomatic Carotid Endarterectomy Trial methods (peak systolic velocity 130 and 230 cm/s on ultrasonography, respectively). The primary endpoint was the lack of major adverse events (MAEs), defined as death, stroke, and myocardial infarction within 30 days, and ipsilateral stroke within 1 year. The performance goal was set at 90.5%. MAE rates were also compared between the CEA high- and normal-risk groups.Results140 carotid artery stenting procedures, including 40% of patients at high risk and 60% at normal risk for CEA, were performed in 13 institutes. MAEs occurred in two cases (one intraprocedural and one postprocedural stroke), and the MAE rate was 1.4%. The non-MAE rate was 98.6% according to Kaplan-Meier analysis, which was superior to the previously set performance goal. The deployment success, target lesion revascularization (TLR), in-stent restenosis, and cerebrovascular event rates were 99.3%, 2.4%, 8.5%, and 7.2%, respectively. The MAE rate in patients with normal CEA risk was 1.2%, which was similar to the high-risk CEA group, with no significant difference due to the small number of MAEs.ConclusionsThe MAE rate following use of the CASPER stent was low (1.4%). The MAE, deployment success, TLR, in-stenosis, and cerebrovascular event rates were similar to those of previous reports.

scholarly journals Postoperative ischemic events in patients undergoing carotid artery stenting using algorithmic selection for embolic protection

2019 ◽  
Vol 32 (4) ◽  
pp. 294-302 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Norio Nakajima ◽  
Hidenori Miyake ◽  
Shunichi Fukuda ◽  
Tetsuya Tsukahara
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Transient Ischemic Attack ◽  
Carotid Artery Stenting ◽  
Minor Stroke ◽  
High Risk Patients ◽  
Embolic Protection ◽  
Risk Patients ◽  
Ischemic Attack

Purpose Carotid artery stenting (CAS) is a valuable alternative to carotid endarterectomy, especially in high-risk patients. However, the reported incidences of perioperative stroke and death remain higher than for carotid endarterectomy, even when using embolic protection devices (EPDs) during CAS. Our purpose was to evaluate 30-day major adverse events after CAS when selecting the most appropriate EPD. Methods We reviewed the clinical outcomes of 61 patients with 64 lesions who underwent CAS with EPDs. Patients who underwent CAS associated with thrombectomy and who had a preoperative modified Rankin scale score >3 were excluded from the analysis. The EPD was selected based on symptoms, carotid wall magnetic resonance imaging and lesion length, and we analyzed combined 30-day complication rates (transient ischemic attack, minor stroke, major stroke or death). Results Forty-nine patients were men and 12 were women. The median age was 72 years (range: 59–89 years) and 44 lesions were asymptomatic. A filter-type EPD was selected in 23 procedures, distal-balloon protection in 14 procedures and proximal-occlusive protection in 27 procedures. Two patients (3.1%) experienced a transient ischemic attack and one patient (1.6%) had a minor stroke within 30 days of the procedure. No patients experienced procedure-related morbidities (modified Rankin score >2) or death. Conclusions The perioperative stoke rate was low when we selected a proximal-occlusive-type EPD in high-risk patients with vulnerable carotid artery disease. Our algorithm for EPD selection was an effective tool in the perioperative management of carotid artery stenosis.

Protected Carotid Artery Stenting in Patients at High Risk for Carotid Endarterectomy

2011 ◽  
Vol 104 (4) ◽  
pp. 257-263 ◽  
Author(s):  
Prasanna Venkatesh Kumar ◽  
Aishwarya Lakshmi ◽  
Rakesh Shrivastava ◽  
Aman Mundi ◽  
Anshu Tandon ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting

scholarly journals Patients Considered “High Risk” For Carotid Endarterectomy are at Increased Risk of Adverse Events After Carotid Artery Stenting

2011 ◽  
Vol 54 (4) ◽  
pp. 1230-1231
Author(s):  
Shunsuke Yoshida ◽  
Christoph S. Nabzdyk ◽  
Julia D. Glaser ◽  
Rodney P. Bensley ◽  
Allen D. Hamdan ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Adverse Events ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Increased Risk

scholarly journals Carotid Artery Stenting With Filter Protection in High-Risk Patients Showing Severe Electroencephalographic Alterations During Carotid Endarterectomy

2006 ◽  
Vol 13 (4) ◽  
pp. 451-456 ◽  
Author(s):  
Roberto Gandini ◽  
Alessio Spinelli ◽  
Sebastiano Fabiano ◽  
Vittorio Colangelo ◽  
Maria Grazia Marciani ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
High Risk Patients ◽  
Risk Patients

Abstract P489: Differences in Characteristics of Octogenarian Patients Undergoing Carotid Artery Stenting and Carotid Endarterectomy for Carotid Stenosis: Insights From a Real World Surgical Quality Registry

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammed Ali Alvi ◽  
Yagiz Yolcu ◽  
Kenan Rajjoub ◽  
Ozan Dikilitas
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Real World ◽  
Carotid Artery Stenting ◽  
Real World Data ◽  
Surgical Quality ◽  
World Data ◽  
Quality Registry

Introduction: Several clinical trials evaluating the efficacy of a carotid revascularization procedure excluded patients above age 80. In the current study, we sought to assess the differences in characteristics of octogenarians undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid stenosis using “real-world” data from a national surgical quality registry. Methods: The National Surgical Quality Improvement Program (NSQIP) targeted datasets for CEA and CAS were queried for patients aged ≥80 years between 2012-2018. Results: We identified 5,814 patients undergoing CEA and 189 patients undergoing CAS. Patients in the CAS group were more likely to be ≥90 years (p=0.004), diabetic (p=0.04), had a history of CHF (p=0.012) and a bleeding-disorder (p<0.001). Patients in the CAS group were also more likely to have high risk anatomy (p<0.001), high-risk-physiology (p=0.028). Ninety-nine (52.4%) patients in the CAS group and 2,775 (47.7%) in the CEA group were symptomatic, with most patients in both groups presenting with an ipsilateral stroke. Among asymptomatic patients, 64 (74%) in the CAS group and 2222 (72.7%) in the CEA group had severe/total stenosis (>80%-100%) of the ipsilateral carotid, while 13(14.5%) in the CAS group and 302 (11%) in the CEA group had severe or total stenosis of contralateral carotid. Among symptomatic patients, 58(61.7%) in the CAS group and 1527 (57.5%) in the CEA group were found to have severe/total stenosis of the ipsilateral-carotid, while 12(12.8%) in the CAS group and 208(7.8%) in the CEA group were found to have severe/total occlusion of the contralateral carotid. In the carotid endarterectomy group, 12.2% (n=711) underwent CEA-alone, 44.3% (n=2,575) CEA with angioplasty, 29.9% (n=1,737) CEA with angioplasty and shunt, 2.9% (n=166) CEA with shunt and 10.7%(n=166) eversion CEA. In the CAS group, 52.4%(n=99) underwent CAS with a single tapered stent, 29.1%(n=55) CAS with single tapered stent with CPD, 11.1%(n=21) single straight stent with CPD and 1.6%(n=3) a single straight stent alone. Conclusion: These analyses from real-world data show that there may be some differences in demographic and comorbid characteristics between octogenarians undergoing CAS and CEA.

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