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Home > Vascular Annual Meeting > SS33. SVS Vascular Registry for Carotid Procedures...

SS33. SVS Vascular Registry® for Carotid Procedures: Comparison of CAS Outcomes for Atherosclerotic Carotid Artery Disease with Non-atherosclerotic Carotid Artery Disease

Rodney A. White1, Gregorio A. Sicard2, Robert M. Zwolak3, Anton N. Sidawy4, Marc L. Schermerhorn5, Flora S. Siami6, SVS Outcomes Committee
1Harbor UCLA Medical Center, Torrance, CA; 2Washington University School of Medicine, St. Louis, MO; 3Dartmouth-Hitchcock Medical Center, Lebanon, NH;4Washington VA Medical Center, Washington, DC;5Beth Israel Deaconess Medical Center, Boston, MA;6New England Research Institutes, Inc., Watertown, MA

OBJECTIVES: The Vascular Registry^® (VR) collects long-term outcomes on CAS and CEA patients. The purpose of this report is to describe peri-operative and 30-day CAS outcomes in patients with atherosclerotic carotid artery disease (ATH) compared with non-atherosclerotic carotid artery disease (NON; including restenosis and radiation-induced stenosis).

METHODS: VR collects provider-reported data on CAS using a web-based database. Data were analyzed at the pre-operative, procedure, pre-discharge, and 30-day intervals.

RESULTS: As of 20/Nov/2008, there were 4,017 CAS patients with discharge data, of which 72% were due to ATH. Of the NON cohort, 76% were restenosis, 16% were radiation-induced, and 8% other. Baseline demographics showed ATH were older (72 yrs vs. 69 yrs, p<0.001), more often male (61% vs. 57%, p=0.02) and more Hispanic-origin (5% vs. 3%, p<0.001). Also, ATH had a higher prevalence of pre-procedure CAD, MI, VHD, CHF, arrhythmia, diabetes, and COPD; whereas NON had a higher prevalence of pre-procedure TMB/amaurosis fugax, smoking, and cancer. Clinically significant intra-procedural arrhythmia (1.7% vs. 0.88%, p=0.04) and hypotension (6.8% vs. 1.8%, p<0.0001) were greater in ATH; while NON had more acute occlusion (0.35% vs. 0.03%, p=0.03). There were no statistically significant differences in death/stroke/MI at peri-operative or 30-day time points (Tables 1, 2). ATH had higher incidence of peri-op TIA (1.5% vs. 0.6%, p=0.02) and close to statistical significance in 30-day TIA (3.2% vs. 1.7%, p=0.052). There were no differences in outcomes when performing gender analysis either within-group or between-group. Finally, there was no statistical difference at 30-day outcome when comparing symptomatic (8.9% ATH vs. 7.4% NON, p=0.53) and asymptomatic (5.6% ATH vs. 4.5% NON, p=0.43) patients

CONCLUSIONS: While ATH patients appear sicker due to statistically significant co-morbidities, they did not have statistically significant increased rates of death/stroke/MI at peri-operative or 30-days when compared with NON. With continued enrollment and follow-up, analysis of VR will supplement RCTs by providing CAS outcomes in current clinical practice with sufficient numbers to serve as an outcome assessment tool of important patient subsets and across the spectrum of peripheral vascular procedures.

AUTHOR DISCLOSURES: R.A. White, None; G.A. Sicard, None; R.M. Zwolak, None; A.N. Sidawy, None; M.L. Schermerhorn, None; F.S. Siami, None.

Table 1.

Table 2.

* 30-day outcomes were defined as any event occurring Pre-Discharge or after discharge up to 30 days. The outcome rates in above tables are per-patient.