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Home > Vascular Annual Meeting > timaran_intracranial_hemorrhage

Intracranial Hemorrhage After Carotid Endarterectomy And Carotid Artery Stenting In The United States In 2005

Carlos H. Timaran¹, Eric B Rosero¹, Frank J. Veith², John G. Clagett¹, Rawson J. Valentine¹, Stephen T. Smith¹, G. Patrick Clagett.^1
1University of Texas Southwestern Medical Center, Dallas, Texas;²Cleveland Clinic Foundation, Cleveland, Ohio.

OBJECTIVES: Intracranial hemorrhage (ICH) following carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare but potentially devastating complication. The effect of more intense dual antiplatelet therapy required for CAS on the frequency of ICH has not been established. This study was undertaken to evaluate the nationwide occurrence of ICH associated with CAS vs. CEA.

METHODS: The Nationwide Inpatient Sample was used to identify patients discharged after CAS and CEA during 2005. The type of revascularization and major adverse events, i.e., in-hospital ICH, stroke and death rates, were determined by cross-tabulating specific procedural codes for CAS and CEA. Risk stratification was performed using the Charlson Comorbidity Index. Univariate and multivariate logistic regression analyses were used to assess the association between type of revascularization, comorbidities, ICH and risk-adjusted mortality.

RESULTS: In 2005, the estimated number of carotid revascularizations was 135,903. The vast majority of patients underwent CEA (90.4%), whereas CAS was performed in 13,093 (9.6%) patients. There was a higher proportion of symptomatic patients in the CAS vs. CEA group (8.8% vs. 7.6%; p<.001). CAS patients had higher postoperative stroke rates (2.1% vs. 1.1%; p<.001) and in-hospital mortality (1.1% vs. 0.6%; p<.001) than CEA patients. ICH occurred in 19 patients (0.15%) after CAS and in 20 patients (0.016%) after CEA (p<.001). CAS was identified as an independent predictor for postoperative stroke (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.5-2.0; p<.001), in-hospital mortality (OR, 1.49; 95%CI, 1.2-1.9; p<.001) and ICH (OR, 6.16; 95%CI, 3.3-11.6; p<.001) after adjusting for age, gender, symptomatic status, comorbidities, admission and hospital type using logistic regression. In-hospital mortality was 12.5% among patients developing ICH (OR, 23.2; 95%CI, 9.1-54.4; p<.001).

CONCLUSIONS: In the United States, patients undergoing CAS have not only significantly increased postoperative stroke and death rates compared with those undergoing CEA, but also a 6-fold increased risk of ICH. Although ICH after CAS is extremely rare, its devastating nature and high mortality warrant further investigation to define specific risk factors, prevention and treatment strategies.

AUTHOR DISCLOSURES: C.H. Timaran, None; E.B. Rosero, None; F.J. Veith, None; J.G. Clagett, None; R.J. Valentine, None; S.T. Smith, None; G.P. Clagett, None.