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Turner AD, Zhu J, Rao A, Ting W, Han D, Tadros R, Finlay D, Vouyouka A, Phair J, Marin M, Faries P. Carotid Stenosis Patients with a Remote History of Cerebrovascular Events have Increased Risk of Major Adverse Events Over Asymptomatic Patients. J Vasc Surg 2022; 76:1625-1632. [PMID: 35868422 DOI: 10.1016/j.jvs.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/02/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Asymptomatic patients with a remote history of transient ischemic attack (TIA) or stroke are not well studied as a separate population from asymptomatic patients with no prior history of TIA or stroke. We compared in-hospital outcomes following transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (TFCAS) among symptomatic, remote history of neurologic symptoms, and asymptomatic patients. METHODS Data from patients in the Vascular Quality Initiative database undergoing TCAR (Jan 2017 to Apr 2020) or TFCAS (May 2005 to Apr 2020) was analyzed. Symptomatic status was defined as TIA and/or stroke occurring within 180 days prior to procedure. Asymptomatic status was divided into patients with no history of TIA/stroke (asymptomatic) and TIA/stroke occurring more than 180 days prior to procedure (remote history of neurologic symptoms). Student's T-test and Pearson Chi-Squared test were used to compare baseline patient characteristics and outcomes. Multivariate logistic regression was used to adjust for significant between-group differences in baseline characteristics. RESULTS There were 7,158 patients who underwent TCAR (symptomatic: 2,574; asymptomatic: 3,689; asymptomatic with a remote history of neurologic symptoms: 895) and 18,023 patients who underwent TFCAS (symptomatic: 6,195; asymptomatic: 10,333; asymptomatic with a remote history of neurologic symptoms: 1,495). Regardless of symptom status, the mean patient age was 73 years for TCAR and 69 years for TFCAS. 64% of patients in the study were male and 36% of patients were female. Mean long-term follow up data ranged between 208 to 331 days within the three patient groups. Carotid stenosis patients with a remote history of neurologic symptoms had higher rates of TIA, stroke, TIA/stroke, stroke/death, and stroke/death/MI than asymptomatic patients, and these rates were similar to those of symptomatic patients. Comparing TCAR and TFCAS among remote history of neurologic symptom patients, there were statistically significant reductions in the odds of stroke/death (OR: 0.46, 95% CI: 0.27-0.84, P = 0.011) and stroke/death/MI (OR: 0.51, 95% CI: 0.30-0.87, P = 0.013) after TCAR. This was likely driven by the increased rate of death for TFCAS remote history of neurologic symptoms patients (0.9%) compared to asymptomatic patients (0.6%). CONCLUSION Asymptomatic patients with a remote history of TIA/stroke do not have the same outcomes as asymptomatic patients without a history of TIA/stroke and are at higher risk of adverse in-hospital events. Patients with a remote history of TIA/stroke have increased risk of in-hospital death after TFCAS and may benefit from TCAR.
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Affiliation(s)
- Anthony D Turner
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - Jerry Zhu
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - Ajit Rao
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - Windsor Ting
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - Daniel Han
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - Rami Tadros
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - David Finlay
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - Ageliki Vouyouka
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - John Phair
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - Michael Marin
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
| | - Peter Faries
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4(th) Floor, Box 1273, New York, NY 10029, United States of America.
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Galyfos GC, Kakisis I, Maltezos C, Geroulakos G. Open versus endovascular treatment of subclavian artery atherosclerotic disease. J Vasc Surg 2019; 69:269-279.e7. [DOI: 10.1016/j.jvs.2018.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
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Neves CRB, Casella IB, da Silva ES, Puech-Leão P. Medical Therapy for Asymptomatic Patients and Stent Placement for Symptomatic Patients Presenting with Carotid Artery Near-Occlusion with Full Collapse. J Vasc Interv Radiol 2018; 29:998-1005. [DOI: 10.1016/j.jvir.2018.01.779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 11/29/2022] Open
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Cremonesi A, Gieowarsingh S, Castriota F. Carotid Artery Angioplasty and Stenting. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Park YJ, Kim DI, Kim GM, Kim DK, Kim YW. Natural History of Asymptomatic Moderate Carotid Artery Stenosis in the Era of Medical Therapy. World Neurosurg 2016; 91:247-53. [DOI: 10.1016/j.wneu.2016.04.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
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Kahles T, Garcia-Esperon C, Zeller S, Hlavica M, Añon J, Diepers M, Nedeltchev K, Remonda L. Mechanical Thrombectomy Using the New ERIC Retrieval Device Is Feasible, Efficient, and Safe in Acute Ischemic Stroke: A Swiss Stroke Center Experience. AJNR Am J Neuroradiol 2015; 37:114-9. [PMID: 26294644 DOI: 10.3174/ajnr.a4463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/15/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Intravenous thrombolysis and mechanical thrombectomy predominantly using stent retrievers have been shown to effectively restore cerebral blood flow and improve functional outcome in patients with acute ischemic stroke. We sought to determine the safety and feasibility of mechanical thrombectomy using the new ERIC retrieval device. MATERIALS AND METHODS We identified 36 consecutive patients from our Stroke Center registry with acute ischemic stroke who were treated with the new ERIC retriever from September 2013 to December 2014. Patients with ischemic stroke meeting the following criteria were eligible: onset-to-treatment time of ≤4.5 hours or wake-up stroke (n = 10) with relevant CT perfusion mismatch, NIHSS score of ≥4, and proof of large-vessel occlusion in the anterior circulation on CT angiography. We assessed the baseline characteristics including age, sex, comorbidities, stroke severity, site of vessel occlusion, presence of tissue at risk, and treatment-related parameters such as onset-to-treatment time, recanalization grade, and outcome. RESULTS The mean age was 70 ± 13 years, and the median NIHSS score on admission was 18 (interquartile range, 10-20). Seventeen of 36 patients were on platelet inhibitors or anticoagulants before endovascular treatment (47.2%); 20 patients received intravenous thrombolysis (55.5%). The ERIC was used as the sole retriever in 28 patients (77.8%) and as a rescue device in 8. Excellent recanalization was achieved in 30/36 patients (83.3%) with TICI 3 in 19/36 and 2b in 11/36, respectively. Median procedural time in these patients was 90 minutes (interquartile range, 58-133 minutes). No intraprocedural complications occurred. CONCLUSIONS In this observational study, the new ERIC retrieval device was technically feasible, safe, and effective in acute ischemic stroke with large-vessel occlusion.
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Affiliation(s)
- T Kahles
- From the Departments of Neurology (T.K., C.G.-E., S.Z., K.N.)
| | | | - S Zeller
- From the Departments of Neurology (T.K., C.G.-E., S.Z., K.N.)
| | - M Hlavica
- Neuroradiology (M.H, J.A., M.D., L.R.), Cantonal Hospital Aarau, Aarau, Switzerland
| | - J Añon
- Neuroradiology (M.H, J.A., M.D., L.R.), Cantonal Hospital Aarau, Aarau, Switzerland
| | - M Diepers
- Neuroradiology (M.H, J.A., M.D., L.R.), Cantonal Hospital Aarau, Aarau, Switzerland
| | - K Nedeltchev
- From the Departments of Neurology (T.K., C.G.-E., S.Z., K.N.)
| | - L Remonda
- Neuroradiology (M.H, J.A., M.D., L.R.), Cantonal Hospital Aarau, Aarau, Switzerland.
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Open Reconstructions for Symptomatic Atherosclerotic Lesions of the Supra-aortic Vessels: Thirty Years Results from Two University Hospitals. Ann Vasc Surg 2015; 29:404-10. [DOI: 10.1016/j.avsg.2014.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/01/2014] [Accepted: 09/12/2014] [Indexed: 11/22/2022]
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Conrad MF, Michalczyk MJ, Opalacz A, Patel VI, LaMuraglia GM, Cambria RP. The natural history of asymptomatic severe carotid artery stenosis. J Vasc Surg 2014; 60:1218-1226. [DOI: 10.1016/j.jvs.2014.05.047] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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Stevens A, Shamseer L, Weinstein E, Yazdi F, Turner L, Thielman J, Altman DG, Hirst A, Hoey J, Palepu A, Schulz KF, Moher D. Relation of completeness of reporting of health research to journals' endorsement of reporting guidelines: systematic review. BMJ 2014; 348:g3804. [PMID: 24965222 PMCID: PMC4070413 DOI: 10.1136/bmj.g3804] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether the completeness of reporting of health research is related to journals' endorsement of reporting guidelines. DESIGN Systematic review. DATA SOURCES Reporting guidelines from a published systematic review and the EQUATOR Network (October 2011). Studies assessing the completeness of reporting by using an included reporting guideline (termed "evaluations") (1990 to October 2011; addendum searches in January 2012) from searches of either Medline, Embase, and the Cochrane Methodology Register or Scopus, depending on reporting guideline name. STUDY SELECTION English language reporting guidelines that provided explicit guidance for reporting, described the guidance development process, and indicated use of a consensus development process were included. The CONSORT statement was excluded, as evaluations of adherence to CONSORT had previously been reviewed. English or French language evaluations of included reporting guidelines were eligible if they assessed the completeness of reporting of studies as a primary intent and those included studies enabled the comparisons of interest (that is, after versus before journal endorsement and/or endorsing versus non-endorsing journals). DATA EXTRACTION Potentially eligible evaluations of included guidelines were screened initially by title and abstract and then as full text reports. If eligibility was unclear, authors of evaluations were contacted; journals' websites were consulted for endorsement information where needed. The completeness of reporting of reporting guidelines was analyzed in relation to endorsement by item and, where consistent with the authors' analysis, a mean summed score. RESULTS 101 reporting guidelines were included. Of 15,249 records retrieved from the search for evaluations, 26 evaluations that assessed completeness of reporting in relation to endorsement for nine reporting guidelines were identified. Of those, 13 evaluations assessing seven reporting guidelines (BMJ economic checklist, CONSORT for harms, PRISMA, QUOROM, STARD, STRICTA, and STROBE) could be analyzed. Reporting guideline items were assessed by few evaluations. CONCLUSIONS The completeness of reporting of only nine of 101 health research reporting guidelines (excluding CONSORT) has been evaluated in relation to journals' endorsement. Items from seven reporting guidelines were quantitatively analyzed, by few evaluations each. Insufficient evidence exists to determine the relation between journals' endorsement of reporting guidelines and the completeness of reporting of published health research reports. Journal editors and researchers should consider collaborative prospectively designed, controlled studies to provide more robust evidence. SYSTEMATIC REVIEW REGISTRATION Not registered; no known register currently accepts protocols for methodology systematic reviews.
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Affiliation(s)
- Adrienne Stevens
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Larissa Shamseer
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
| | - Erica Weinstein
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA
| | - Fatemeh Yazdi
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Lucy Turner
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Justin Thielman
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, UK
| | - Allison Hirst
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - John Hoey
- Population and Public Health Initiative, Queen's University, Kingston, ON, Canada, K7L 3N6
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y9 Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V5Z 1M9
| | - Kenneth F Schulz
- International Clinical Sciences Support Center, FHI 360, Durham, NC 27713, USA
| | - David Moher
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
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Diehm N, Vermassen F, van Sambeek M. Standardized Definitions and Clinical Endpoints in Trials Investigating Endovascular Repair of Aortic Dissections. Eur J Vasc Endovasc Surg 2013; 46:645-50. [DOI: 10.1016/j.ejvs.2013.08.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
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Conrad MF, Baloum V, Mukhopadhyay S, Garg A, Patel VI, Cambria RP. Progression of asymptomatic carotid stenosis despite optimal medical therapy. J Vasc Surg 2013; 58:128-35.e1. [DOI: 10.1016/j.jvs.2013.04.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/29/2013] [Accepted: 04/05/2013] [Indexed: 11/25/2022]
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