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Kazantsev AN, Korotkikh AV, Wang S, Gloria Nonye O, Artyukhov SV, Mukhtorov OS, Roshkovskaya LV, Zakharova KL, Unguryan VM, Shmatov DV, Urokov DA, Choriev AA, Zabolotniy VN, Lebedev OV, Zarkua NE, Kravchuk VN, Alekseyeva EO, Bagdavadze GS, Chernyavin MP, Leader RY, Solobuev AI, Vaiman EF, Kazantseva EG, Lutsenko VA, Sultanov RV, Matusevich VV, Zakeryaev AB, Sukhoruchkin PV. Carotid endarterectomy for symptomic and asymptomic stenosis: Report of 65388 cases (Russian register). Vascular 2024:17085381241259928. [PMID: 38848729 DOI: 10.1177/17085381241259928] [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: 06/09/2024]
Abstract
AIM Analysis of in-hospital and long-term results of carotid endarterectomy in patients with asymptomatic and symptomatic stenoses. MATERIALS AND METHODS The sample was formed by completely including all cases of carotid endarterectomy (n = 65,388) performed during the period from May 1, 2015 to November 1, 2023. Depending on the symptomatic/asymptomatic nature of the stenosis, all patients were divided into two groups: group 1 - n = 39,172 (75.2%) - patients with asymptomatic stenosis; Group 2 - n = 26216 (24.8%) - patients with symptomatic stenosis. The postoperative follow-up period was 53.5 ± 31.4 months. RESULTS In the hospital postoperative period, the groups were comparable in the incidence of death (group 1: n = 164 (0.41%); group 2: n = 124 (0.47%); p = .3), transient ischemic attack (group 1: n = 116 (0.29%); group 2: n = 88 (0.33%); p = .37), myocardial infarction (group 1: n = 32 (0.08%); group 2: n = 19 (0.07%); p = .68), thrombosis of the internal carotid artery (group 1: n = 8 (0.02%); group 2: n = 2 (0.007%); p = 0, 19), bleeding (group 1: n = 58 (0.14%); group 2: n = 33 (0.12%); p = .45). In group 2, ischemic stroke developed statistically more often (group 1: n = 328 (0.83%); group 2: n = 286 (1.09%); p = .001), which led to a higher value of the combined endpoint (group 1: n = 640 (1.63%); group 2: n = 517 (1.97%); p = .001). In the long-term postoperative period, the groups were comparable in cases of death (group 1: n = 65 (0.16%); group 2: n = 41 (0.15%); p = .76) and death from cardiovascular causes (group 1: n = 59 (0.15%); group 2: n = 33 (0.12%); p = .4). A greater number of ischemic strokes were detected in patients of group 2 (group 1: n = 213 (0.54%); group 2: n = 187 (0.71%); p = .006). In group 1, hemodynamically significant restenosis (≥70%) of the internal carotid artery was more often diagnosed (group 1: n = 974 (2.49%); group 2: n = 351 (1.34%); p < .0001) and myocardial infarction (group 1: n = 66 (0.16%); group 2: n = 34 (0.13%); p < .0001). When analyzing stroke-free survival, analysis of Kaplan-Meier curves showed that a statistically larger number of strokes were diagnosed in group 2 (p < .0001). CONCLUSION Due to the fact that the patients were initially not comparable for a number of indicators, to achieve balance, we applied propensity score matching analysis. Thus, group 1 consisted of 24,381 patients, and group 2 consisted of 17,219 patients. In the hospital postoperative period, statistically significant differences were obtained only in the combined end point, which was greater in group 2 (group 1: n = 465 (1.9%); group 2: n = 382 (2.2%); p = .02). In the long-term follow-up period, after applying propensity score matching, no statistically significant differences were obtained between groups.
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Affiliation(s)
- Anton N Kazantsev
- Kostroma Regional Clinic, Kostroma, Russian Federation
- Russian Scientific Center for Surgery Named After Academician B.V. Petrovsky, Moscow, Russian Federation
- Kostroma Oncology Dispensary, Kostroma, Russian Federation
| | - Alexander V Korotkikh
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russian Federation
| | - Showen Wang
- First Moscow State Medical University. THEM. Sechenov, Moscow, Russian Federation
| | | | - Sergey V Artyukhov
- State Budgetary Healthcare Institution "City Alexander Hospital", St. Petersburg, Russian Federation
| | | | - Lyudmila V Roshkovskaya
- State Budgetary Healthcare Institution "City Alexander Hospital", St. Petersburg, Russian Federation
| | - Kristina L Zakharova
- State Budgetary Healthcare Institution "City Alexander Hospital", St. Petersburg, Russian Federation
| | | | - Dmitry V Shmatov
- St. Petersburg State University, St. Petersburg, Russian Federation
| | | | | | | | | | - Nona E Zarkua
- Northwestern State Medical University Named After Mechnikov, St. Petersburg, Russian Federation
| | - Vyacheslav N Kravchuk
- Northwestern State Medical University Named After Mechnikov, St. Petersburg, Russian Federation
| | - Elena O Alekseyeva
- Novgorod State University Named After Yaroslav the Wise, Veliky Novgorod, Russian Federation
| | | | - Maxim P Chernyavin
- Clinical Hospital of the Administration of the President of the Russian Federation, Moscow, Russian Federation
| | - Roman Yu Leader
- Kemerovo State Medical University, Kemerovo, Russian Federation
| | | | | | | | - Viktor A Lutsenko
- Kemerovo Regional Clinical Hospital Named After S.V. Belyaev, Kemerovo, Russian Federation
| | - Roman V Sultanov
- Kemerovo Regional Clinical Hospital Named After S.V. Belyaev, Kemerovo, Russian Federation
| | - Vyacheslav V Matusevich
- Scientific Research Institute - Ochapovsky Regional Clinic Hospital №1, Krasnodar, Russian Federation
| | - Aslan B Zakeryaev
- Scientific Research Institute - Ochapovsky Regional Clinic Hospital №1, Krasnodar, Russian Federation
| | - Pavel V Sukhoruchkin
- Scientific Research Institute - Ochapovsky Regional Clinic Hospital №1, Krasnodar, Russian Federation
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Joviliano EE, Ribeiro MS, Sobreira ML, Moura R, Geiger MA, Guillamon AT, Regina de Oliveira Raymundo S, Miquelin DG, Hafner L, Almeida MJ, Oliveira TF, Dalio MB, Yoshida WB. Short-term outcomes of transfemoral carotid artery stenting and carotid endarterectomy in symptomatic patients: data from a multicentric prospective registry in Brazil. Ann Vasc Surg 2022; 85:41-48. [PMID: 35589029 DOI: 10.1016/j.avsg.2022.04.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transfemoral carotid artery stenting (TF-CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. Since their main objective is to prevent future ischemic events, regular reassessment of the outcomes is mandatory for providing the best therapy. OBJECTIVE The purpose of this study was to describe the practice and the outcomes of TF-CAS and CEA in symptomatic patients in public university hospitals in Brazil, using data from a prospective multicentric registry. METHODS Prospective 8-year observational study of patients with symptomatic carotid artery atherosclerotic disease that underwent TF-CAS and CEA in five public university hospitals affiliated with the RHEUNI (Registry Project of Vascular Disease in the Public University Hospitals of São Paulo). All consecutive procedures were included. The indications for the procedures were determined by each surgeon's individual discretion, in accordance with a preoperative risk evaluation. The outcome measures were any 30-day follow-up death, stroke, myocardial infarction (MI), and their combined outcome (major adverse cardiovascular events - MACE). The registration of the study was made at clinicaltrials.gov NCT02538276. RESULTS From January 2012 through December 2019, 376 consecutive and symptomatic patients were included in the study records. There were 152 TF-CAS procedures (40.4%) and 224 CEA procedures (59.5%). All completed the 30-day follow-up period. Occurrence of death (TR-CAS: 0.66% x CEA: 0.66%, P=0.99), stroke (TF-CAS: 4.61% x CEA: 4.46%, P=0.99), and MI (TF-CAS: 0.66% x CEA: 0%, P=0.403) was similar in both groups, without statistically significant differences. MACE rate did not differ in both groups (TF-CAS: 5.92% x CEA: 4.46%, P=0.633). CONCLUSIONS Data from a prospective registry of five Brazilian university hospitals showed that transfemoral carotid artery stenting and carotid endarterectomy in symptomatic patients had similar 30-day perioperative rates of death, stroke, and myocardial infarction and their combination.
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Affiliation(s)
| | | | | | - Regina Moura
- University Hospital of Botucatu Medical School - São Paulo State University
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