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 PVSS5. Preoperative Symptom Type Influences the Early Outcomes of Carotid Endarterectomy (CEA) and Carotid Stenting (CAS) in the Society for Vascular Surgery Vascular Registry® (SVS-VR)

​Patrick Geraghty1, Thomas E. Brothers2, David L. Gillespie3, Gilbert R. Upchurch4, Michael C. Stoner5, Flora S. Siami6, Christopher T. Kenwood6, Philip P. Goodney7
1Washington University School of Medicine, St Louis, MO; 2Medical University of South Carolina, Charleston, SC; 3University of Rochester Medical Center, Rochester, NY; 4University of Virginia Medical School, Charlottesville, VA; 5East Carolina University, Greenville, NC; 6New England Research Institutes, Inc, Watertown, MA; 7Dartmouth-Hitchcock Medical Center, Lebanon, NH.

OBJECTIVES: To determine the effect of specific symptom types on outcomes of CEA and CAS in contemporary vascular surgical practice.

METHODS: Retrospective review of all SVS-VR patients treated with CEA or CAS. Patients were segregated by 12-month pre-procedural ipsilateral symptom status: stroke (CVA), hemispheric transient ischemic attack (TIA), transient monocular blindness (TMB) or asymptomatic (ASX). Simple and risk-adjusted odds ratios were used to compare the likelihood of the 30-day outcomes of death, CVA, myocardial infarction (MI), and the composite outcomes of death/CVA, and death/CVA/MI.
 
RESULTS: Symptom type significantly influences risk-adjusted 30-day outcomes for carotid intervention, more markedly in patients undergoing CAS than CEA (Table). Bivariate analyses confirm a hierarchical relationship, with pre-procedural stroke predicting the poorest outcomes, followed by TIA. Thirty-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 carotid intervention in contemporary vascular surgical practice, with a more prominent effect on CAS outcomes than CEA outcomes.
 
AUTHOR DISCLOSURES: T. E. Brothers: Nothing to disclose; P. Geraghty: Nothing to disclose; D. L. Gillespie: Nothing to disclose; P. P. Goodney: Nothing to disclose; C. T. Kenwood: Nothing to disclose; F. S. Siami: Nothing to disclose; M. C. Stoner: Nothing to disclose; G. R. Upchurch: Nothing to disclose.

Odds ratios for bivariate comparisons of 30-day outcomes, stratified by procedure
​30-Day Death, Stroke, MI Preop Ipsilateral Symptom Type​

Multivariate (adjusted) Logistic Model​    

​OR (95% CI) ​p-value
CAS (n=3236) ​ ​CVA (v TIA) ​1.33 (0.88 - 2.02) ​0.1812
​CVA (v TMB) ​2.86 (1.36, 6.01) ​0.0056*
​CVA (v ASX) ​2.47 (1.70, 3.58) ​<0.0001*
​TIA (v TMB) ​2.15 (1.04, 4.46) ​0.0393
​TIA (v ASX) ​1.86 (1.32, 2.62) ​0.0004*
​TMB (v ASX) ​0.86 (0.43, 1.75) ​0.6857
CEA (n=5780)​ ​CVA (v TIA) ​1.30 (0.83, 2.03) ​0.2492
​CVA (v TMB) ​2.56 (1.18, 5.57) ​0.0174
​CVA (v ASX) ​2.10 (1.45, 3.05) ​<0.0001*
​TIA (v TMB) ​1.97 (0.91, 4.26) ​0.0837
​TIA (v ASX)  ​1.62 (1.13, 2.31) ​0.0084
​TMB (v ASX) ​0.82 (0.40, 1.70) ​0.5917
* Denotes significant p-values of <0.0083, accounting for multiple comparisons
​  ​  ​  ​ 
 
Posted April 2013

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