Objective The objective of this study was to determine the effect

Objective The objective of this study was to determine the effect of presenting symptom types on 30-day periprocedural outcomes of carotid endarterectomy (CEA) and carotid AZD-9291 artery stenting (CAS) in contemporary vascular practice. likelihood of the 30-day outcomes of death stroke and myocardial infarction (MI) and the composite outcomes of death + stroke and death + stroke + MI. Results Symptom type significantly influences risk-adjusted 30-day outcomes for carotid intervention. Presentation with stroke predicted the poorest outcomes (death + stroke + MI composite: OR 1.3 95 confidence interval [CI] 0.83 vs TIA; OR 2.56 95 CI 1.18 vs TMB; OR 2.12 95 CI 1.46 vs ASX) followed by TIA (death + stroke + MI composite: OR 1.97 95 CI 0.91 vs TMB; OR 1.63 95 CI 1.14 vs ASX). For both CAS and CEA patients presentation with stroke AZD-9291 or TIA predicted a higher risk of periprocedural stroke than in ASX patients. Presentation with stroke predicted higher 30-day risk of death with CAS but not with CEA. MI rates were not affected by presenting symptom type. The 30-day outcomes for the TMB and ASX patient groups were equivalent in both treatment arms. Conclusions Presenting symptom type significantly affects the 30-day outcomes of both CAS and CEA in contemporary vascular surgical practice. Presentation with stroke and TIA predicts higher rates of periprocedural complications whereas TMB presentation predicts a periprocedural risk profile similar to that of ASX disease. In addition to prior completed ipsilateral stroke hemispheric transient ischemic attack (TIA) ipsilateral to significant carotid bifurcation stenosis has long been known to predict subsequent ipsilateral stroke and excess cardiovascular mortality.1 2 In similar fashion transient monocular blindness (TMB also known as amaurosis fugax) associated with carotid bifurcation stenosis foretells an elevated risk of subsequent stroke although less than that described for TIA.3 The North American Symptomatic Carotid Endarterectomy Trial (NASCET) firmly established the benefit of carotid endarterectomy (CEA) for symptomatic moderate to severe carotid stenoses.4 5 NASCET also added to our knowledge of the natural history of symptomatic carotid disease; analysis of the medical treatment arm of NASCET demonstrated a higher 2-year risk of stroke for patients presenting with hemispheric TIA (43.5% ± 6.7%) in comparison to TMB (16.6% ± 5.6%).6 Separate examination of surgical results from NASCET showed that procedural stroke outcomes were poorer for patients presenting with hemispheric TIA rather than TMB 7 confirming the findings of earlier investigators.8 Yet even as NASCET and the Asymptomatic Carotid Atherosclerosis Study9 established the primacy of CEA for stroke reduction in AZD-9291 symptomatic and asymptomatic lesions early experiences with angioplasty and stent placement for carotid disease were being reported.10 11 During the next decade carotid artery stenting (CAS) was compared with CEA in randomized trials ranging from the Stenting and Angioplasty with Protection in Patients with High Risk for Endarterectomy (SAPPHIRE) study to the more recent and better powered Carotid Revascularization Endarterectomy vs Stenting Trial (CREST).12 13 Both trials enrolled asymptomatic and symptomatic patients and their publication has provided further insight into the comparative benefits of CAS and CEA. However neither study examined the relationship of presenting symptom type (stroke TIA or TMB) to procedural outcomes. The Society for Vascular Surgery Vascular Registry (SVS-VR) carotid module collected demographic procedural and outcomes data from contributing centers for CEA and CAS from 2004 through 2011. By the nature of registry design patients entered into the SVS-VR are unmatched yet risk-adjusted data from this “real-world” experience provide valuable insight into current AZD-9291 vascular surgical outcomes.14 Using the SVS-VR we sought to determine Rabbit Polyclonal to KLHL3. the effect of presenting symptom type on early outcomes of CEA and CAS in contemporary vascular practice. METHODS The derivation of 30-day periprocedural outcomes data from the SVS-VR inclusive of procedural and predischarge data has AZD-9291 previously been reported.14 All registry patients who underwent CEA or CAS with available 30-day outcomes reporting were identified. For clarity of comparison carotid procedures undertaken for atherosclerotic radiation-induced or restenotic lesions of the carotid bifurcation and internal carotid artery were included but procedures undertaken for trauma dissection or unspecified causes were excluded. Procedures undertaken only on the common carotid or external carotid arteries were excluded. CEA and CAS.