Introduction Carotid endarterectomy and carotid stenting (CAS) have shown comparable outcomes in symptomatic patients. However, the optimal timing of CAS is debatable. We aim to evaluate the safety and efficacy of CAS when performed emergently during hospitalization of symptoms onset as compare to an elective procedure in a subsequent admission.
Methods We performed a retrospective analysis of CAS patients admitted to our comprehensive stroke center and included all the patients with TIA/stroke and ipsilateral extracranial carotid stenosis >50% from January 2015 to September 2019. Medical records were reviewed for demographics, clinical data and outcomes. The primary outcome was defined as any stroke, myocardial infarction or death related to the procedure at 3 months of follow-up. Secondary outcomes were minor neurological (seizures or TIA at discharge) and non-neurological (bradycardia, hypotension, groin ecchymosis and/or hematoma, retroperitoneal hematoma, pneumonia, and atrial fibrillation at discharge) complications at discharge, and rate of restenosis or occlusion at follow-up (defined as a Peak Systolic Velocity by duplex ultrasonography greater than 300 cm/s or stenosis greater than 70% by angiography). Stepwise backward multivariable regression and Time-to-event analyses were used for comparisons.
Results We identified 75 emergent and 104 elective patients. Emergent differed significantly from elective patients in the rates of dyslipidemia (44% vs. 66%, p=0.003), length of hospitalization (4.9% vs. 1.2%, p=0.002), ipsilateral carotid occlusion (17% vs. 2%, p<0.001), general anesthesia (19% vs. 4%, p=0.001) and treatment with Tirofiban during procedure (13% vs. 4%, p=0.008). There was no significant difference in primary outcome (9.3% vs. 3.8%, p=0.21), minor neurological (3% vs. 0.9%, p=0.572) or non-neurological (15% vs. 11%, p=0.411) complication rates. CAS is not associated with the primary outcome (OR: 3.29, CI: 0.83 – 16.2, p=0.18) after adjusting for ipsilateral carotid occlusion. Treatment with Tirofiban during procedure was associated with all minor complications (OR: 2.88, CI: 1.53 – 5.43, p<0.001) after adjusting for male sex and age >75 years. Of all the 23 minor complications, 8 (34.7%) were due to groin and retroperitoneal hematoma. The Kaplan-Meier estimate for the frequency of restenosis or occlusion was 7% for emergency CAS group and 11.6% for elective CAS group with a mean follow-up of 12.8 months (log rank p=0.3).
Conclusions CAS in emergency symptomatic patients has comparable safety outcomes to elective patients at 3 months follow-up. Similarly, both groups have similar rates of restenosis at long-term follow-up (12.8 months).
Disclosures D. Quispe Orozco: None. K. Limaye: None. C. Zevallos Mau: None. A. Mendez Ruiz: None. S. Abdelkarim: None. S. Ansari: None. A. Mendez Ruiz: None. M. Farooqui: None. S. Dandapat: None. E. Samaniego: None. S. Ortega Gutierrez: 2; C; Medtronic, Stryker.
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