We have located links that may give you full text access.
Journal Article
Multicenter Study
Observational Study
Long-term outcomes after carotid artery stenting of patients with prior neck irradiation or surgery.
BACKGROUND: Carotid artery stenting (CAS) is often performed in patients with carotid artery stenosis who have relative contraindications to carotid endarterectomy (CEA), including hostile neck anatomy (e.g., history of neck irradiation or prior surgery). We examined the impact of hostile neck anatomy on long-term outcomes after CAS.
METHODS: All carotid artery stent procedures performed at two institutions from 2006 to 2016 were reviewed. Routine duplex carotid ultrasound was used to assess target lesion restenosis at regular intervals. The primary endpoint was rates of target lesion revascularization (TLR). Secondary endpoints included peri-procedural outcomes, restenosis, stroke, major adverse cardiovascular and cerebrovascular events (MACCE), and mortality during long-term follow up. A Cox proportional hazard model was developed to determine the association between hostile neck anatomy and outcome after CAS.
RESULTS: 304 CAS procedures were performed in 268 patients (hostile neck=53, non-hostile neck=215). Patients with hostile neck anatomy were more likely to have a history of smoking and history of prior carotid artery revascularization. There were no differences in peri-procedural outcomes including stroke. During follow-up to five years there were no significant differences in rates of TLR (1.4% vs. 3.8%, P=0.25), restenosis (1.9% vs. 5.1%, P=0.31), MACCE (26% vs. 18%, P=0.15), ipsilateral stroke (7.5% vs. 2.8%, P=0.101), or mortality (13% vs. 14%, P=0.89). Hostile neck anatomy was not associated with significantly increased 5-year TLR rates in the Cox regression analysis (HR=2.64; 95% CI: 0.44-15.83; P=0.289).
CONCLUSIONS: Despite greater comorbidities, patients with hostile neck anatomy and carotid artery stenosis have favorable outcomes after carotid artery stenting.
METHODS: All carotid artery stent procedures performed at two institutions from 2006 to 2016 were reviewed. Routine duplex carotid ultrasound was used to assess target lesion restenosis at regular intervals. The primary endpoint was rates of target lesion revascularization (TLR). Secondary endpoints included peri-procedural outcomes, restenosis, stroke, major adverse cardiovascular and cerebrovascular events (MACCE), and mortality during long-term follow up. A Cox proportional hazard model was developed to determine the association between hostile neck anatomy and outcome after CAS.
RESULTS: 304 CAS procedures were performed in 268 patients (hostile neck=53, non-hostile neck=215). Patients with hostile neck anatomy were more likely to have a history of smoking and history of prior carotid artery revascularization. There were no differences in peri-procedural outcomes including stroke. During follow-up to five years there were no significant differences in rates of TLR (1.4% vs. 3.8%, P=0.25), restenosis (1.9% vs. 5.1%, P=0.31), MACCE (26% vs. 18%, P=0.15), ipsilateral stroke (7.5% vs. 2.8%, P=0.101), or mortality (13% vs. 14%, P=0.89). Hostile neck anatomy was not associated with significantly increased 5-year TLR rates in the Cox regression analysis (HR=2.64; 95% CI: 0.44-15.83; P=0.289).
CONCLUSIONS: Despite greater comorbidities, patients with hostile neck anatomy and carotid artery stenosis have favorable outcomes after carotid artery stenting.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app