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 RR16. Symptom Status and Degree of Ipsilateral Stenosis Determine Whether Contralateral Stenosis Increases the Risk for Carotid Revascularization

Margriet Fokkema1, Philip P. Goodney2, April E. Nedeau3, Yvonne R. Baribeau4, Virendra I. Patel5, Frans L. Moll6, Gert Jan de Borst6, Marc L. Schermerhorn1
1Surgery, Beth Israel Deaconess Medical Center, Boston, MA; 2Dartmouth-Hitchcock Medical Center, Lebanon, NH; 3Central Maine Medical Center, Lewiston, ME; 4New England Heart Institute, Manchester, NH; 5Massachusetts General Hospital, Boston, MA; 6University Medical Center Utrecht, Utrecht, Netherlands.

OBJECTIVES: The impact of degree of contralateral stenosis on outcome after CAS and CEA remains unknown. We aimed to identify those patients at increased procedural risk due to contralateral stenosis or occlusion (CO).
METHODS: All patients undergoing CEA or CAS in the Vascular Study Group of New England were identified from 2003-2011. Patients were stratified by symptom status and degree of ipsilateral stenosis. Primary endpoint was any stroke or death (S/D) at 30 days. Bivariate and multivariable analyses (adjusted for age, gender and procedure) were done to assess the impact of the degree of contralateral stenosis as assessed by Duplex Ultrasound.
RESULTS: 9,362 CEA patients (33.4% symptomatic [sx]) and 663 CAS patients (34.4% sx) were included. Contralateral disease did not impact outcome in asymptomatic (asx) patients with 50-80% ipsilateral stenosis. Asx patients with ipsilateral >80% stenosis and CO had significantly increased S/D rate (3.4%, p<0.01, OR 5.4 [2.6-11.4]). Sx patients with >80% ipsilateral stenosis were not impacted by contralateral stenosis, while those with 50-80% ipsilateral stenosis and 80-99% contralateral stenosis had the highest S/D rate (6.9%, p=0.05, OR 5.1 [1.1-24.7]).
CONCLUSIONS: The impact of contralateral disease on outcome after carotid revascularization is different for asx versus sx patients. Regardless of procedure, CO increases the risk for asx patients with >80% ipsilateral stenosis, while 80-99% contralateral stenosis increases the risk for sx patients with 50-80% ipsilateral stenosis.
AUTHOR DISCLOSURES: Y. R. Baribeau: Nothing to disclose; G. de Borst: Nothing to disclose; M. Fokkema: Nothing to disclose; P. P. Goodney: Nothing to disclose; F. L. Moll: Nothing to disclose; A. E. Nedeau: Nothing to disclose; V. I. Patel: Nothing to disclose; M. L. Schermerhorn: Endologix, Consulting fees or other remuneration (payment); Medtronic, Consulting fees or other remuneration (payment).

30-day stroke/death rate in symptomatic and asymptomatic undergoing CEA or CAS
​ CS < 50%  ​ ​CS 50-79%  ​ CS 80-99%​  ​ ​CO  ​  ​ ​Total
 ​ ​N ​% ​N ​% ​N ​% ​N ​% ​P-value ​N ​%
ASX​ ​Ipsi 50-80% (n=1655) ​9 ​0.9 ​3 ​0.6 ​0 ​0 ​1 ​0.9 ​0.88 ​13 ​0.8
 ​ ​Ipsi >80% (n= 4945) ​18 ​0.7 ​14 ​0.9 ​1 ​0.3 ​12 ​3.4 ​<.001 ​45 ​0.9
​SX ​ Ipsi 50-80% (n=1115) ​10 ​1.4 ​7 ​2.4 ​2 ​6.9 ​3 ​5.1 ​0.05 ​22 ​0.2
​Ipsi >80% (n= 2195) ​25 ​2.1 ​11 ​1.7 ​6 ​3.5 ​2 ​1.7 ​0.56 ​44 ​2.1
CS, contralateral stenosis; CO, contralateral occlusion; ASX, asymptomatic; SX, symptomatic; ipsi, ipsilateral
Posted April 2013

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