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Desantis C, Zacà S, Wiesel P, Mastrangelo G, Pulli R, Angiletta D. Sex-Related Outcomes in Asymptomatic Patients Undergoing Carotid Artery Stenting. J Endovasc Ther 2023:15266028231172356. [PMID: 37190763 DOI: 10.1177/15266028231172356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE Aim of the study was to evaluate the influence of sex in asymptomatic patients undergoing carotid artery stenting (CAS). MATERIALS AND METHODS A retrospective observational study was conducted from January 2006 to December 2020. A total of 438 consecutive patients with asymptomatic carotid artery stenosis >70% underwent transfemoral CAS and were stratified in males (M) and females (F). Periprocedural 30-day outcomes were: stroke, death, and myocardial infarction (MI). Follow-up outcomes were: death and stroke rates (primary) and freedom from restenosis (FFR) and reintervention rates (secondary). Follow-up data were analyzed at 1, 5, and 10 years. Data were analyzed with χ2 test and Fisher's exact test and follow-up outcomes with Kaplan-Meier curves. The log-rank test was used to determine differences between the groups and univariate analysis to identify the association between risk factors and intraoperative details with mortality and restenosis rates. RESULTS A total of 462 procedures were performed (M: n=321, 69.4%), in which 24 CAS were bilateral (5.5%). Mean age was 71.9±7.6 years (M: 72.1±7.8; F: 71.7±7.3). Periprocedural outcomes were: stroke rate 2.2% (n=10; M: n=5, 1.6%; F: n=5, 3.5%; p=0.176), mortality rate 0.6% (M: n=3, p=0.334), and stroke/death rate 2.8% (n=13; M: n=8, 2.5%; F: n=5, 3.5%; p=0.528); no cardiac events (MI) were recorded. A not-disabling (minor) stroke was detected in 3 males (0.9%), while a disabling (major) stroke was reported in 7 patients (1.7%) of whom 5 were ischemic events (M: n=2, 0.6%; F: n=3, 2.2%) and 2 were cerebral hemorrhages (F: 1.3%, p=0.046). Mean follow-up was 73.66±40.83 months (M: 72.66; F: 76.01; p=0.246). Overall survival rate was 96.1% (95% confidence interval [CI]: 93-98), 81.8% (95% CI: 77-86), and 45.5% (95% CI: 38-53) at 1, 5, and 10 years, respectively (p=0.236). The overall stroke rate was 0.3% (freedom from stroke [FFS]: 99.7%; 95% CI: 98-100), 0.9% (FFS: 99%; 95% CI: 98-100), and 4.3% (FFS: 95.7%; 95% CI: 89-98; M: n=6; F: n=2; p=0.774). Stroke-related mortality rate was 0.7% (FFS: 99.3%; 95% CI: 97-100) and 2.9% (FFS: 97.1%; 95% CI: 91-99) at 5 and 10 years, respectively, without differences between the groups (M: n=4; F: n=2; p=0.763). Overall FFR rate was 97.4% (95% CI: 95-99), 93.4% (95% CI: 90-96), and 89.5% (95% CI: 84-93; p=0.322). Two severe symptomatic restenosis (>70%, M) required a new endovascular revascularization. CONCLUSION The sex variable does not influence outcomes of CAS in asymptomatic patients at short- and long-term follow-up, although females show a worst incidence of periprocedural major strokes. Carotid artery stenting may be safely proposed when a careful patient selection is applied. CLINICAL IMPACT The sex variable has been advocated as a considerable factor that could influence the outcomes of transfemoral carotid artery stenting (CAS). Literature data are contrasting, even if different papers mainly reported that CAS is associated to worst outcomes in female patients. Our study shows that the sex-variable does not influence outcomes of CAS in asymptomatic patients at short and long-term follow-up, although females had a worst incidence of periprocedural major strokes. CAS may be safely proposed when a careful patient selection is applied.
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Affiliation(s)
- Claudio Desantis
- Vascular and Endovascular Surgery-Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Sergio Zacà
- Vascular and Endovascular Surgery-Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Paola Wiesel
- Vascular and Endovascular Surgery-Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Giovanni Mastrangelo
- Vascular and Endovascular Surgery-Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Raffaele Pulli
- Vascular and Endovascular Surgery-Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy
| | - Domenico Angiletta
- Vascular and Endovascular Surgery-Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy
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Esposito A, Menna D, Baiano A, Benedetto P, DI Leo F, Trani A, Cappiello AP. Carotid endarterectomy with saphenous vein patch angioplasty: a single-center experience. Minerva Cardiol Angiol 2023; 71:120-125. [PMID: 34472771 DOI: 10.23736/s2724-5683.21.05685-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND When performing a conventional CEA it is recommended the use of patch angioplasty (PA), since previous meta-analyses have shown PA to be superior to primary closure (PRC) in terms of stroke and restenosis rates. Different materials patches can be employed although none of them has been proved to be superior. Although autologous veins are potentially more resistant to immediate thrombosis as well as infection, cons may be represented by patch rupture and late dilatation. Aim of this study is to evaluate immediate and long-term results of CEA with saphenous vein patch angioplasty (SVPA) in a single-center experience. METHODS A retrospective study was performed analyzing all patients undergoing CEA with SVPA at our institution from January 2012 to March 2020. CEA was performed in symptomatic patients with 50-99% carotid stenosis degree or asymptomatic patients with 70-99% stenosis degree. Exclusion criteria were critical limb ischemia, varicose disease, unavailability of saphenous veins, vein diameter <3.5 mm. All CEAs were performed under general anesthesia with routine shunting. Primary endpoints were perioperative stroke, death, carotid thrombosis and hematoma requiring surgery rates. Secondary endpoints included the rate of recurrent stenosis >70%, patch aneurysm/rupture/infection at follow-up. RESULTS Overall, 488 interventions were performed on 461 patients. Most patients were male (77.8%) with a mean age of 71.2±8.3 years. Thirty-day mortality and stroke rates were 0.4% and 1.2% respectively. Carotid thrombosis occurred in five patients (1%). Five patients (1%) developed a surgical site hematoma requiring surgical drainage. At a mean follow-up of 34.4±25.8 months 12 restenoses (2.5%) were detected. Five-year freedom from restenosis rate was 96.7%. Restenosis at follow-up was more frequent in patients who had contralateral carotid stenosis (P=0.019). Two patients (0.4%) developed carotid patch aneurysmal degeneration at a mean follow-up of 78.7 months. No infection nor patch disruption were detected. CONCLUSIONS CEA with SVPA resulted safe and effective in terms of early and late results. The perioperative complications rates we recorded were quite similar to those reported by other larger reviews and meta-analyses.
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Affiliation(s)
- Andrea Esposito
- Division of Vascular Surgery, Cardiovascular Department, San Carlo Hospital, Potenza, Italy
| | - Danilo Menna
- Division of Vascular Surgery, Cardiovascular Department, San Carlo Hospital, Potenza, Italy -
| | - Angela Baiano
- Division of Vascular Surgery, Cardiovascular Department, San Carlo Hospital, Potenza, Italy
| | - Pietro Benedetto
- Division of Vascular Surgery, Cardiovascular Department, San Carlo Hospital, Potenza, Italy
| | - Ferdinando DI Leo
- Division of Vascular Surgery, Cardiovascular Department, San Carlo Hospital, Potenza, Italy
| | - Antonio Trani
- Division of Vascular Surgery, Cardiovascular Department, San Carlo Hospital, Potenza, Italy
| | - Antonino P Cappiello
- Division of Vascular Surgery, Cardiovascular Department, San Carlo Hospital, Potenza, Italy
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Mayorga-Carlin M, Shaw P, Ozsvath K, Erben Y, Wang G, Sahoo S, Macdonald S, Kashyap VS, Sorkin JD, Lal BK. Transcarotid revascularization outcomes do not differ by patient age or sex. J Vasc Surg 2022; 76:209-219.e2. [PMID: 35358669 DOI: 10.1016/j.jvs.2022.01.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transcarotid artery revascularization (TCAR) is a hybrid approach to carotid revascularization. Limited information is available on the differences in periprocedural complications and performance measures of TCAR for men compared with women and for older vs younger adults. METHODS The patient, lesion, and physician characteristics were collected for all TCAR procedures performed by each physician worldwide in an international quality assurance database between March 3, 2009 and May 7, 2020. Clinical composite (ie, death, stroke, transient ischemic attack, myocardial infarction) and technical composite (ie, aborted procedure, conversion to surgery, bleeding, dissection, cranial nerve injury, device failure) adverse events within 24 hours of the procedure were recorded. Four performance measures were recorded: flow-reversal time, fluoroscopy time, contrast volume, and skin-to-skin time. Poisson regressions were used to assess the effects of age and sex on the incidence of clinical and technical composite adverse events. Linear regressions were used to compare the four performance measures. RESULTS A total of 18,240 TCARs were performed by 1273 physicians; 34.9% of the patients were women and 37.5% were symptomatic. The overall incidence of clinical and technical composite adverse events was low. The adjusted clinical (1.62% [95% confidence interval (CI), 1.17%-2.23%] vs 1.35% [95% CI, 1.01%-1.79%]; P = .22) and technical (7.84% [95% CI, 6.85%-8.97%] vs 7.80% [95% CI, 6.94%-8.77%]; P = .93) composite adverse event rates did not vary for women vs men. The adjusted clinical (P = .65) and technical (P = .55) composite adverse event rates also did not vary by age. The adjusted skin-to-skin time was shorter for the women (76.6 minutes; 95% CI, 74.6-78.6) than for the men (77.7 minutes; 95% CI, 75.7-79.6; P = .002). Significant differences were found by age group for fluoroscopy time, flow-reversal time, and skin-to-skin time, although the magnitude of these differences was small (<1 minute for each). CONCLUSIONS The clinical and technical outcomes of TCAR are not affected by age or sex. We found clinically minor differences in the procedural performance measures when stratified by age and sex. In addition to being safe for younger individuals, TCAR could also be the preferred method for performing carotid stenting in women and older patients, in particular, older women.
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Affiliation(s)
| | - Palma Shaw
- Division of Vascular Surgery, Upstate University, Syracuse, NY
| | - Kathleen Ozsvath
- Division of Vascular Surgery, St. Peter's Health Partners, Troy, NY
| | - Young Erben
- Division of Vascular Surgery, Mayo Clinic, Jacksonville, FL
| | - Grace Wang
- Division of Vascular Surgery, University of Pennsylvania, Philadelphia, PA
| | - Shalini Sahoo
- Division of Vascular Surgery, University of Maryland, Baltimore, MD
| | | | - Vikram S Kashyap
- Division of Vascular Surgery, Case Western Reserve University, Cleveland, OH
| | - John D Sorkin
- Department of Medicine, University of Maryland, Baltimore, MD; Geriatric Research Education and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Brajesh K Lal
- Division of Vascular Surgery, University of Maryland, Baltimore, MD; Vascular Service, Baltimore Veterans Affairs Medical Center, Baltimore, MD.
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Hicks CW, Daya NR, Black JH, Matsushita K, Selvin E. Race and sex-based disparities associated with carotid endarterectomy in the Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2020; 292:10-16. [PMID: 31731080 PMCID: PMC6928429 DOI: 10.1016/j.atherosclerosis.2019.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/12/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS The indications for carotid endarterectomy (CEA) are well established. The aim of the current study was to investigate sex and race-based disparities in the incidence of CEA after adjusting for carotid artery stenosis risk factors. METHODS We conducted a prospective cohort analysis of 14,492 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study without prevalent stroke at baseline (1987-1989). We used Kaplan-Meier curves and Cox proportional hazards models adjusting for sociodemographic, cardiovascular, and disease severity risk factors to quantify the associations of sex and race with incident CEA. RESULTS CEA was performed in 330 of 14,492 ARIC participants during a median of 27 years of follow-up [incidence rate 1.00 (95% CI 0.90-1.12) per 1000 persons-years]. The crude incidence of CEA varied significantly by sex [female vs. male: HR 0.60 (95% CI 0.48-0.74)] and race [black vs. white: HR 0.65 (95% CI 0.49-0.86)]. Adjustment for sociodemographic and cardiovascular risk factors, carotid intima-media thickness, and symptomatic status attenuated the association of sex with CEA [females vs. males HR 0.96 (0.76-1.22)], but black participants had a lower risk of incident CEA after adjustment [HR 0.68 (95% CI 0.49-0.95)]. CONCLUSIONS We found significant variation in the incidence of CEA procedures based on race that was independent of traditional risk factors and carotid IMT. Whether this disparity is a reflection of differences in disease presentation or access to care deserves investigation.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Natalie R Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Jeong MJ, Kwon SU, Kim MJ, Han Y, Kwon TW, Cho YP. Effects of patient age on outcomes after carotid endarterectomy: A retrospective, single-center study in Korea. Medicine (Baltimore) 2019; 98:e16781. [PMID: 31393403 PMCID: PMC6708719 DOI: 10.1097/md.0000000000016781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In this single-center, retrospective study, we aimed to compare early and late outcomes after carotid endarterectomy (CEA) between younger and elderly patients and to investigate the impact of patient age on the overall incidence of cardiovascular events after CEA.A total of 613 patients with 675 CEAs between January 2007 and December 2014 were stratified by patient age into 2 groups: younger (≤60 years, n = 103 CEAs, 15.3%) and elderly (>60 years, n = 572 CEAs, 84.7%) groups. The study outcomes were defined as the occurrence of major adverse events (MAEs), including fatal or nonfatal stroke or myocardial infarction (MI), or any-cause mortality, and overall cardiovascular events (meaning the composite incidence of stroke or MI) during the perioperative period and within 4 years after CEA.Although there were no significant differences in the incidence of 30-day MAEs and any of the individual MAE manifestations between the 2 groups, the differences in the MAE incidence (P = .006) and any-cause mortality (P = .023) within 4 years after CEA were significantly greater in patients in the elderly group. For overall incidence of cardiovascular events, no significant difference was noted between the 2 groups (P = .096). On multivariate analysis, older age (>60 years) did not affect the incidence of perioperative MAEs and individual MAE manifestations; however, older age was significantly associated with an increased risk of 4-year MAEs (hazard ratio [HR], 3.68, 95% confidence interval [CI], 1.35-10.0; P = .011) and any-cause mortality (HR, 3.26, 95% CI, 1.02-10.5; P = .047). With regard to the 4-year overall incidence of cardiovascular events, older age was not an independent predictor of increased risk of these cardiovascular events.Our study indicates that the risks of perioperative MAEs and the 4-year overall incidence of cardiovascular events do not significantly differ between younger and elderly Korean patients undergoing CEA, although there was a higher risk of 4-year any-cause mortality in the elderly patients. Older age does not appear to be an independent risk factor for perioperative MAEs and overall cardiovascular events within 4 years after CEA.
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Affiliation(s)
| | | | - Min-Ju Kim
- Departments of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Youngjin Han
- Department of Surgery, Division of Vascular Surgery
| | - Tae-Won Kwon
- Department of Surgery, Division of Vascular Surgery
| | - Yong-Pil Cho
- Department of Surgery, Division of Vascular Surgery
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Roussopoulou A, Tsivgoulis G, Krogias C, Lazaris A, Moulakakis K, Georgiadis GS, Mikulik R, Kakisis JD, Zompola C, Faissner S, Chondrogianni M, Liantinioti C, Hummel T, Safouris A, Matsota P, Voumvourakis K, Lazarides M, Geroulakos G, Vasdekis SN. Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis: an international multicenter study. Eur J Neurol 2018; 26:673-679. [PMID: 30472766 DOI: 10.1111/ene.13876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0-2 days) in comparison to early (3-14 days) CEA in patients with sCAS. METHODS Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. RESULTS A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%-17.7%) and early (4.4%; 95% confidence interval 2.4%-7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4-6) vs. 10 days (interquartile range 7-14); P < 0.001]. CONCLUSIONS Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.
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Affiliation(s)
- A Roussopoulou
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - G Tsivgoulis
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Krogias
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - A Lazaris
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - K Moulakakis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - G S Georgiadis
- Department of Vascular Surgery, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - R Mikulik
- Department of Neurology, St Anne's University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - J D Kakisis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Zompola
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - S Faissner
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - M Chondrogianni
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Liantinioti
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - T Hummel
- Department of Vascular Surgery, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - A Safouris
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece.,Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | - P Matsota
- Second Department of Anaesthesiology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - K Voumvourakis
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - M Lazarides
- Department of Vascular Surgery, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - G Geroulakos
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - S N Vasdekis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
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Wang C, Lv G, Zang D. Risk factors of carotid plaque and carotid common artery intima-media thickening in a high-stroke-risk population. Brain Behav 2017; 7:e00847. [PMID: 29201548 PMCID: PMC5698865 DOI: 10.1002/brb3.847] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/01/2017] [Accepted: 08/28/2017] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION To analyze the risk factors of carotid plaque (CP) and carotid common artery intima-media thickening (CCAIMT) and the association between the risk factors and CP numbers and the side of the CCAIMT in a high-stroke-risk population. METHODS Carotid ultrasonography was conducted in 2025 participants with high stroke risk. Participants were divided into different groups according to the results of the ultrasound. The risk factors and blood biochemical indices were recorded. RESULTS The presence of CP and CCAIMT were 38.9% and 24.8% respectively. Multivariate logistic regression indicated that the risk factors of CP were age, high LDL-C and FBG levels, male gender, stroke, diabetes, hypertension, and tobacco use. Compared with participants without CPs, the participants who were male, and older in age, with risk factors of tobacco use, diabetes, high LDL-C levels, and a family history of hypertension were likely to have a single CP, whereas the participants with risk factors of tobacco use, diabetes, hypertension, male gender, older age, high LDL-C levels, stroke and AF or valvulopathy were prone to have multiple CPs. The risk factors of CCAIMT were male gender, stroke, hypertension, diabetes, AF or valvulopathy, tobacco use and age. Compared with the N-CCAIMT subgroup, the risk factors of left CCAIMT were tobacco use, diabetes, male gender, and age. The risk factors of right CCAIMT were male gender, high FBG levels, age, AF or valvulopathy. The risk factors of dual CCAIMT were high frequency of drinking milk, tobacco use, male gender, age, stroke, and hypertension. CONCLUSION These findings revealed the risk factors of CP and CCAIMT, and an association between the risk factors and the CP numbers and the side of the CCAIMT.
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Affiliation(s)
- ChunFang Wang
- First Central Clinical College of Tianjin Medical University Tianjin China.,Department of Neurology Tianjin First Central Hospital Tianjin China
| | - GaoPeng Lv
- Department of Neurology Tianjin First Central Hospital Tianjin University of Traditional Chinese Medicine Tianjin China
| | - DaWei Zang
- Department of Neurology Tianjin First Central Hospital Tianjin Medical University Tianjin China
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Carotid artery stenting is associated with a higher incidence of major adverse clinical events than carotid endarterectomy in female patients. J Vasc Surg 2017; 66:794-801. [DOI: 10.1016/j.jvs.2017.03.413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/01/2017] [Indexed: 11/23/2022]
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Dorigo W, Fargion A, Giacomelli E, Bassoli G, Pulli R, Pratesi G, Piffaretti G, Pratesi C. A Matched Case-Control Study on Early and Late Results of Carotid Endarterectomy Performed in Young Patients. World J Surg 2017; 42:263-271. [PMID: 28733710 DOI: 10.1007/s00268-017-4133-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of the study was to describe the perioperative and long-term results of carotid endarterectomy (CEA) in patients aged 60 or less and compare them to patients of more advanced age in a retrospective single-centre case-control study. METHODS From January 1996 to December 2014, 5893 consecutive CEAs were performed in our institution. Data concerning these interventions were prospectively inserted in a dedicated database. A retrospective analysis of that database was performed and 457 interventions performed in patients aged 60 or less were found (group 1). The control group was represented by 457 interventions selected from the remaining 5436 by a one-to-one coarsened exact matching on the basis of all the baseline demographic and clinical covariates significantly different in the two groups (group 2). The two groups were compared in terms of intraoperative technical features and perioperative (<30 days) results of interventions (transient ischaemic attack-TIA, stroke and death rates) with χ 2 test. Follow-up data were analysed by life-table analysis (Kaplan-Meier test) in terms of survival, stroke-free and neurological symptom-free survival, freedom from severe restenosis and occlusion and freedom from reintervention, and the results in the two groups were compared by means of log rank test. RESULTS There were no differences between the two groups in terms of clinical presentation and of degree of carotid stenosis on operated side. Anaesthesiological and surgical details were also similar between the two groups. Thirty-day stroke and death rate was 0.6% in both groups (p = 0.9). Follow-up was available for 877 patients (96% of the study group) with a mean duration of 50 months. Estimated 10-year survival rates were 85% in group 1 (SE 0.03) and 76% in group 2 (SE 0.04, p = 0.003, log rank 8.9). At the same time interval, stroke-free survival was also significantly better in group 1 (85%, SE 0.035) than in group 2 (72.5%, SE 0.03; p = 0.002, log rank 10.1). The corresponding figures in terms of any neurological symptom-free survival were 82.8% in group 1 (SE 0.04) and 70.3% in group 2 (SE 0.04, p = 0.002, log rank 9.7). Estimated freedom from severe restenosis and occlusion was 76.5% in group 1 (SE 0.04) and 88.5% in group 2 (SE 0.035, p = 0.001, log rank 11.9). Disease recurrence was symptomatic in six cases, three in each group. Estimated freedom from reintervention rates at 10 years was 87% in group 1 (SE 0.035) and 91.5% in group 2 (SE 0.03; p = 0.2, log rank 1.1). CONCLUSIONS CEA in patents aged 60 or less is safe and provides significantly better long-term results than those obtained in patients over 60 in terms of survival and stroke-free survival. Younger patients appear to have higher rates of recurrent carotid stenosis compared to the older cohort; however, these rarely require a secondary intervention.
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Affiliation(s)
- Walter Dorigo
- Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Largo Brambilla 3, 50134, Florence, Italy.
| | - Aaron Fargion
- Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Largo Brambilla 3, 50134, Florence, Italy
| | - Elena Giacomelli
- Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Largo Brambilla 3, 50134, Florence, Italy
| | - Giulia Bassoli
- Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Largo Brambilla 3, 50134, Florence, Italy
| | - Raffaele Pulli
- Department of Vascular Surgery, University of Bari, Bari, Italy
| | - Giovanni Pratesi
- Department of Vascular Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Carlo Pratesi
- Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, Careggi University Teaching Hospital, University of Florence School of Medicine, Largo Brambilla 3, 50134, Florence, Italy
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10
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Tsivgoulis G, Katsanos AH, Caso V. Under-representation of women in stroke randomized controlled trials: inadvertent selection bias leading to suboptimal conclusions. Ther Adv Neurol Disord 2017; 10:241-244. [PMID: 28529545 DOI: 10.1177/1756285617699588] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/20/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, 'Attikon University Hospital', Iras 39, Gerakas Attikis, Athens, 15344, Greece
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, 'Attikon University Hospital', Athens, Greece Department of Neurology, University of Ioannina, Ioannina, Greece
| | - Valeria Caso
- Stroke Unit, Department of Medicine and Cardiovascular Medicine, University of Perugia, Perugia, Italy
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11
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Pelisek J, Wendorff H, Wendorff C, Kuehnl A, Eckstein HH. Age-associated changes in human carotid atherosclerotic plaques. Ann Med 2016; 48:541-551. [PMID: 27595161 DOI: 10.1080/07853890.2016.1204468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Little is known about changes in carotid plaque morphology during aging and the possible impact on cardiovascular events. Only few studies addressed so far age-related modifications within atherosclerotic lesions. Therefore, in this work we endeavored to summarize the current knowledge about changing of plaque composition in elderly. The data from hitherto existing studies confirm that atherosclerotic plaques undergo distinct alternations with advanced age. However, the results are often ambiguous and the changes do not seem to be as disastrous as expected. Interestingly, none of the studies could definitely evidence increased plaque vulnerability with advanced age. Nevertheless, based on the previous work showing decrease in elastin fibers, fibroatheroma, SMCs, overall cellularity and increase in the area of lipid core, hemorrhage, and calcification, the plaque morphology appears to transform toward unstable plaques. Otherwise, even if inflammatory cells often accumulate in plaques of younger patients, their amount is reduced in the older age and so far no clear association has been observed between thin fibrous cap and aging. Thus, the accurate contribution of age-related changes in plaque morphology to cardiovascular events has yet to be elucidated. KEY MESSAGES Composition of carotid atherosclerotic lesions changes during aging. These alternations are however, just moderate and depend upon additional variables, such as life style, accompanying disease, genetics, and other factors that have yet to be determined. Based on the current data, the age-associated plaque morphology seems to transform toward vulnerable plaques. However, the changes do not seem to be as disastrous as expected.
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Affiliation(s)
- Jaroslav Pelisek
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| | - Heiko Wendorff
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| | - Carina Wendorff
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| | - Andreas Kuehnl
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| | - Hans-Henning Eckstein
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
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12
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Selwaness M, Hameeteman R, Van 't Klooster R, Van den Bouwhuijsen Q, Hofman A, Franco OH, Niessen WJ, Klein S, Vernooij MW, Van der Lugt A, Wentzel JJ. Determinants of carotid atherosclerotic plaque burden in a stroke-free population. Atherosclerosis 2016; 255:186-192. [PMID: 27806835 DOI: 10.1016/j.atherosclerosis.2016.10.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS In a large stroke-free population, we sought to identify cardiovascular risk factors and carotid plaque components associated with carotid plaque burden, lumen volume and stenosis. METHODS The carotid arteries of 1562 stroke-free participants from The Rotterdam Study were imaged on a 1.5-Tesla MRI scanner. Inner and outer wall of the carotid arteries were automatically segmented and lumen volume (mm3), wall volume (outer wall-inner wall) and plaque burden (wall volume/outer wall volume) (%) were quantified. Plaque components were visually determined and luminal stenosis was assessed. We analyzed associations of cardiovascular risk factors and carotid plaque components with plaque burden and lumen volumes using regression analysis. RESULTS We investigated 2821 carotid plaques and found that women had larger plaque burden (50.7 ± 7.8% vs. 49.2 ± 7.7%, p < 0.0001) and smaller lumen volumes (933 ± 286 mm3vs. 1078 ± 334 mm3, p < 0.0001) than men. In women, age, HDL-cholesterol and systolic blood pressure, and in men, total cholesterol, non-HDL cholesterol and statin use were independently associated with higher plaque burden and lumen volume. Furthermore, smoking and diabetes were associated with lumen volume in men (respectively p = 0.04 and p = 0.002). Intraplaque hemorrhage (IPH) and lipid were related to a larger plaque burden (OR 1.30 [1.05-1.60] and OR 1.28[1.06-1.55]). Finally, within the highest quartile of plaque burden, IPH was strongly associated with luminal stenosis independent of age, sex, plaque burden and composition (Beta = 15.2; [11.8-18.6]). CONCLUSIONS Several cardiovascular risk factors and plaque components, in particular IPH, are associated with higher plaque burden. Carotid IPH is strongly associated with an increased luminal stenosis.
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Affiliation(s)
| | - Reinhard Hameeteman
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ronald Van 't Klooster
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Albert Hofman
- Department of Epidemiology, MC, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, MC, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands; Faculty of Applied Sciences, Delft University of Technology, The Netherlands
| | - Stefan Klein
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, MC, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
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13
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Tromba L, Tartaglia F, Blasi S, Giuliani A, Carbotta S, Kiltzanidi D, Cavaiola S, Tortorelli G, Carbotta G, Pelle F. Is Carotid Stenosis in Women a Gender-Related Condition? J Womens Health (Larchmt) 2015; 25:348-54. [PMID: 26555221 DOI: 10.1089/jwh.2015.5300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We set out to study, through ultrasound examinations, the carotid bifurcation in men and women with/without carotid stenosis to look for anatomical and electrophysiologic differences. We evaluated other variables to look for differences that might explain the dissimilar behavior of this disease in the two sexes and the presence and impact of risk factors. METHODS We examined 974 subjects aged 25 to 88 years (478 men and 496 women) in whom we considered heart rate, smoking status, and the presence of hypertension, diabetes, hypercholesterolemia, and hypertriglyceridemia. Ultrasound examination of the neck vessels included measurement of intimal medial thickness (IMT), vessel diameter, and outflow area/inflow area ratio. We established plaque location, echogenicity and echostructure, and the percentage of stenosis owing to plaque and measured systolic velocity, flow direction, and the depth of detection of these parameters. We used the apnea and hyperpnea test to assess cerebrovascular reactivity. RESULTS Hypertension and hypercholesterolemia were the most frequent risk factors. Women had a higher heart rate, whereas men had significantly greater IMT. The presence of atheromatous plaque was significantly correlated with age in both sexes, with men having a higher prevalence of carotid plaques. The sexes differed significantly with regard to plaque location, echogenicity, echostructure, and intracranial circulation. Women had a slightly higher blood flow velocity in the intracranial arteries. Risk factors affected plaque formation and extent more in men than in women. CONCLUSIONS These findings suggest that carotid stenosis is a gender-related trait.
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Affiliation(s)
- Luciana Tromba
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | | | - Sara Blasi
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | | | - Sabino Carbotta
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | - Demetra Kiltzanidi
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | - Stefania Cavaiola
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | | | - Giovanni Carbotta
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
| | - Fabio Pelle
- 1 Surgical Sciences Department, Sapienza University of Rome , Rome, Italy
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14
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Dong C, Della-Morte D, Cabral D, Wang L, Blanton SH, Seemant C, Sacco RL, Rundek T. Sirtuin/uncoupling protein gene variants and carotid plaque area and morphology. Int J Stroke 2015; 10:1247-52. [PMID: 26332421 DOI: 10.1111/ijs.12623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sirtuins and uncoupling proteins have been implicated in cardiovascular diseases by controlling oxidative stress. AIMS We sought to investigate the association of sirtuins and uncoupling proteins single nucleotide polymorphisms with total carotid plaque area and morphology measured by ultrasonographic gray scale median. METHODS We analyzed 1356 stroke-free subjects (60% women, mean age = 68 ± 9 years) from the Northern Manhattan Study. Multiple linear regression models were used to evaluate the association of 85 single nucleotide polymorphisms in 11 sirtuins/uncoupling protein genes with total plaque area and gray scale median after controlling for demographics, vascular risk factors (RFs), and population stratification. We investigated effect modifications of these relationship by gender and RFs and performed stratified analysis if the interaction effect had P < 0·005. RESULTS Among individuals with present plaque (55%), the mean total plaque area was 20·3 ± 20·8 mm(2) and gray scale median 90 ± 29. After adjustment, SIRT6 rs107251 was significantly associated with total plaque area (β = 0·30 per copy of T allele increase, Bonferroni-corrected P = 0·005). T allele carriers of rs1430583 in UCP1 showed a decreased gray scale median in women but not in men. The minor allele carriers of rs4980329 and rs12363280 in SIRT3 had higher gray scale median in men but not in women. Variants in UCP3 gene were significantly associated with higher mean gray scale median in individuals with dyslipidemia. CONCLUSION Our findings suggest that polymorphisms in SIRT6/UCP1 genes may be important for increased carotid plaque burden and echodensity, but translation of these findings to an individual risk of cerebrovascular events needs further investigation. Significant associations of rs1430583 in women, rs12363280 in men, and rs1685354 in those with dyslipidemia also deserve further investigations.
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Affiliation(s)
- Chuanhui Dong
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David Della-Morte
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.,Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS San Raffaele Pisana, Rome, Italy
| | - Digna Cabral
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Liyong Wang
- John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Susan H Blanton
- John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Chaturvedi Seemant
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.,John T. McDonald Department of Human Genetics, John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA.,Department of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.,Department of Epidemiology, Miller School of Medicine, University of Miami, Miami, FL, USA
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15
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Luebke T, Brunkwall J. Meta- analysis and meta-regression analysis of the associations between sex and the operative outcomes of carotid endarterectomy. BMC Cardiovasc Disord 2015; 15:32. [PMID: 25956903 PMCID: PMC4432947 DOI: 10.1186/s12872-015-0029-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/21/2015] [Indexed: 12/26/2022] Open
Abstract
Background Subgroup analyses from randomized controlled trials (RCT) of carotid endarterectomy (CEA) for both symptomatic and asymptomatic carotid stenosis suggest less benefit in women compared to men, due partly to higher age-independent peri-operative risk. However, a meta-analysis of case series and databases focussing on CEA-related gender differences has never been investigated. Methods A systematic review of all available publications (including case series, databases and RCTs) reporting data on the association between sex and procedural risk of stroke and/or death following CEA from 1980 to 2015 was investigated. Pooled Peto odds ratios of the procedural risk of stroke and/or death were obtained by Mantel-Haenszel random-effects meta-analysis. The I2 statistic was used as a measure of heterogeneity. Potential publication bias was assessed with the Egger test and represented graphically with Begg funnel plots of the natural log of the OR versus its standard error. Additional sensitivity analyses were undertaken to evaluate the potential effect of key assumptions and study-level factors on the overall results. Meta-regression models were formed to explore potential heterogeneity as a result of potential risk factors or confounders on outcomes. A tria sequential analysis (TSA) was performed with the aim to maintain an over- all 5 % risk of type I error, being the standard in most meta- analyses and systematic reviews. Results 58 articles reported combined stroke and mortality rates within 30 days of treatment. In the unselected overall meta-analysis, the incidence of stroke and death in the male and female groups differed significantly (Peto OR, 1,162; 95 % CI, 1.067-1.266; P = .001), revealing a worse outcome for female patients. Moderate heterogeneity among the studies was identified (I2 = 36 %), and the possibility of publication bias was low (P = .03). In sensitivity analyses the meta-analysis of case series with gender aspects as a secondary outcome showed a significantly increased risk for 30-day stroke and death in women compared to men (Peto OR, 1.390; 95 % CI, 1.148-1.684; P = .001), In contrast, meta-analysis of databases (Peto OR, 1.025; 95 % CI, 0.958-1.097; P = .474) and case series with gender related outcomes as a primary aim (Peto OR, 1.202; 95 % CI, 0.925-1.561; P = .168) demonstrated no increase in operative risk of stroke and death in women compared to men. Conclusions Metanalyses of case series and databases dealing with CEA reveal inconsistent results regarding gender differences related to CEA-procedure and should not be transferred into clinical practice.
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Affiliation(s)
- Thomas Luebke
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germay.
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germay.
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16
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Sex-associated differences in the modulation of vascular risk in patients with asymptomatic carotid stenosis. J Cereb Blood Flow Metab 2015; 35:684-8. [PMID: 25586143 PMCID: PMC4420889 DOI: 10.1038/jcbfm.2014.248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/27/2014] [Accepted: 12/11/2014] [Indexed: 11/09/2022]
Abstract
In this study, we aimed to identify determinants of the different sex-related stroke risk in subjects with asymptomatic internal carotid artery (ICA) stenosis. In all, 492 women (44.4%) and 617 men (55.6%), with unilateral ⩾ 60% asymptomatic ICA stenosis, were prospectively evaluated with a median follow-up of 37 months (interquartile range, 26 to 43). Vascular risk profile, plaque characteristics, stenosis progression, and common carotid artery intima-media thickness were investigated. Outcome measure was the occurrence of ischemic stroke ipsilateral to ICA stenosis. Myocardial infarction, contralateral stroke and transient ischemic attack were considered as competing events. The incidence rate of ipsilateral stroke over the entire follow-up period was 0.16%: 0.09% (95% confidence interval (CI) 0.05 to 0.15) in women and 0.22% (95% CI 0.17 to 0.29) in men (log-rank test, P<0.001). Stenosis progression significantly influenced the risk of ipsilateral stroke in both men (subhazard ratio, SHR, 8.99) and women (SHR 4.89). Stenosis degree (71% to 90%, SHR 2.35; 91% to 99%, SHR 3.38) and irregular plaque surface (SHR 2.32) were relevant risk factors for ipsilateral stroke only in men. Our findings suggest that characteristics of the stenosis and plaque exert a different effect in modulating vascular risk in the two sexes. Understanding sex differences in cardiovascular disease could help to target sex-specific future therapies.
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17
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Tsivgoulis G, Krogias C, Georgiadis GS, Mikulik R, Safouris A, Meves SH, Voumvourakis K, Haršány M, Staffa R, Papageorgiou SG, Katsanos AH, Lazaris A, Mumme A, Lazarides M, Vasdekis SN. Safety of early endarterectomy in patients with symptomatic carotid artery stenosis: an international multicenter study. Eur J Neurol 2014; 21:1251-7, e75-6. [DOI: 10.1111/ene.12461] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Affiliation(s)
- G. Tsivgoulis
- Second Department of Neurology; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
- Department of Neurology; Democritus University of Thrace; School of Medicine; Alexandroupolis Greece
- International Clinical Research Center; St Anne's University Hospital in Brno; Brno Czech Republic
| | - C. Krogias
- Department of Neurology; St Josef Hospital; Ruhr University; Bochum Germany
| | - G. S. Georgiadis
- Department of Vascular Surgery; Democritus University of Thrace; School of Medicine; Alexandroupolis Greece
| | - R. Mikulik
- International Clinical Research Center; St Anne's University Hospital in Brno; Brno Czech Republic
- Department of Neurology; St Anne's University Hospital and Medical Faculty of Masaryk University; Brno Czech Republic
| | - A. Safouris
- Stroke Unit; Department of Neurology; Brugmann University Hospital; Brussels Belgium
| | - S. H. Meves
- Department of Neurology; St Josef Hospital; Ruhr University; Bochum Germany
| | - K. Voumvourakis
- Second Department of Neurology; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
| | - M. Haršány
- International Clinical Research Center; St Anne's University Hospital in Brno; Brno Czech Republic
- Department of Neurology; St Anne's University Hospital and Medical Faculty of Masaryk University; Brno Czech Republic
| | - R. Staffa
- 2nd Department of Surgery; St Anne's University Hospital, and Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - S. G. Papageorgiou
- Second Department of Neurology; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
| | - A. H. Katsanos
- Department of Neurology; University of Ioannina; School of Medicine; Ioannina Greece
| | - A. Lazaris
- Vascular Unit; 3rd Surgical Department; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
| | - A. Mumme
- Department of Vascular Surgery; St Josef Hospital; Ruhr University; Bochum Germany
| | - M. Lazarides
- Department of Vascular Surgery; Democritus University of Thrace; School of Medicine; Alexandroupolis Greece
| | - S. N. Vasdekis
- Vascular Unit; 3rd Surgical Department; ‘Attikon’ Hospital; University of Athens; School of Medicine; Athens Greece
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