PC202. Patients More Likely to Die or Have a Stroke Following Carotid Artery Stenting vs Carotid Endarterectomy: Comparing 11-year Survival and Postoperative Stroke Using Vascular Quality Initiative Data Matched to Medicare Claims Data

Abstract Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days. Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.

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Meta-Analysis of the Procedural Risks of Carotid Endarterectomy and Carotid Artery Stenting Over Time

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.04.008 ◽

2018 ◽

Vol 67 (6) ◽

pp. 1934-1935

Author(s):

K. Lokuge ◽

D.D. de Waard ◽

A. Halliday ◽

A. Gray ◽

R. Bulbulia ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Over Time

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PCN194 Comparing Complex Machine Learning Models to Predict Likelihood of Ovarian Cancer Using Medicare Claims DATA

Value in Health ◽

10.1016/j.jval.2021.04.285 ◽

2021 ◽

Vol 24 ◽

pp. S56

Author(s):

M. Zhang ◽

V. Mansfield

Keyword(s):

Machine Learning ◽

Ovarian Cancer ◽

Claims Data ◽

Learning Models ◽

Medicare Claims ◽

Medicare Claims Data ◽

Machine Learning Models

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Hemodynamic Changes and Baroreflex Sensitivity Associated with Carotid Endarterectomy and Carotid Artery Stenting

Interventional Neurology ◽

10.1159/000366231 ◽

2014 ◽

Vol 3 (1) ◽

pp. 13-21 ◽

Cited By ~ 11

Author(s):

Qinqin Cao ◽

Jun Zhang ◽

Gelin Xu

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Baroreflex Sensitivity ◽

Hemodynamic Changes

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Endovascular Advances for Extracranial Carotid Stenosis

Neurosurgery ◽

10.1227/neu.0000000000000223 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S92-S101 ◽

Cited By ~ 1

Author(s):

Jorge L. Eller ◽

Travis M. Dumont ◽

Grant C. Sorkin ◽

Maxim Mokin ◽

Elad I. Levy ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Carotid Stenting ◽

Historical Background ◽

Treatment Modalities ◽

Endovascular Management ◽

The Past

Abstract Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background.

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