Joseph J. Ricotta1, Gilbert R. Upchurch2, Gregg S. Landis3, Christopher T. Kenwood4, Flora S. Siami4, John J. Ricotta5, Rodney A. White6
1Emory University School of Medicine, Atlanta, GA; 2University of Virginia, Charlottesville, VA; 3New York Hospital Queens, New York, NY; 4New England Research Institutes, Inc., Watertown, MA; 5Washington Hospital Center, Washington, DC; 6Harbor UCLA, Los Angeles, CA.
OBJECTIVES: Data on the influence of contralateral carotid occlusion (CCO) on carotid endarterectomy (CEA) are conflicting and are absent for carotid stenting (CAS). This study evaluated the influence of CCO on CEA and CAS.
METHODS: We evaluated patients (pts) with and without CCO in the SVS Vascular Registry. Primary outcome was a composite of periprocedural death, stroke, or MI (MACE) and its individual components. Further analysis was done to identify the influence, if any of symptom status on outcomes.
RESULTS: There were 1,128 CAS and 666 CEA pts with CCO. CAS pts were more often symptomatic with a higher incidence of coronary artery disease, congestive heart failure, diabetes, COPD, and NYHA >3. Absolute risk of periprocedural MACE (2.75% CAS vs. 4.20% CEA), death (1.06% CAS vs. 0.75% CEA), stroke (2.13% CAS vs. 3.15% CEA), and MI (CAS 0.35% vs. 0.60% CEA) was statistically equivalent for both. This equivalence was maintained when pts with CCO were segregated by symptom status and after adjusting for periprocedural risk.
There were 16,646 pts without contralateral occlusion (NCO) (5,698 CAS; 10,948 CEA). NCO pts with CEA have better outcomes in periprocedural MACE (1.76% NCO vs. 4.20% CCO), and stroke (1.06% NCO vs. 3.15% CCO) (p<0.0001 for both). In CAS pts, CCO did not significantly affect periprocedural MACE (3.16% NCO vs. 2.75% CCO), death (0.8% NCO vs. 1.0% CCO), stroke (2.3% NCO vs. 2.1% CCO) or MI (0.6% vs. NCO s 0.3% CCO). In CEA pts, CCO increased MACE, primarily by increasing stroke rates in both asymptomatic (0.68 % vs. 2.00%, p=0.0095) and symptomatic (1.68% vs. 4.89%, p=0.0012) pts.
CONCLUSIONS: While CEA is preferred in NCO pts, regardless of symptom status, based on lower periprocedural MACE, death and stroke, the benefit of CEA is lost in pts with CCO because of increased stroke rates in CCO pts after CEA but not CAS regardless of symptom status. The results of CAS and CEA in patients with CCO are equivalent and within acceptable AHA guidelines.
AUTHOR DISCLOSURES: C. T. Kenwood, Nothing to disclose; G. S. Landis, Nothing to disclose; J. J. Ricotta, Nothing to disclose; J. J. Ricotta, Nothing to disclose; F. S. Siami, Nothing to disclose; G. R. Upchurch, Nothing to disclose; R. A. White, Nothing to disclose.
Posted April 2012