title: Carotid revascularization immediately before urgent cardiac surgery practice patterns associated with the choice of carotid artery stenting or endarterectomy: a report from the CARE (Carotid Artery Revascularization and Endarterectomy) registry.
abstract: OBJECTIVE
  We describe characteristics associated with use of endarterectomy (CEA) versus stenting (CAS) in patients before urgent cardiac surgery.
  
  
  BACKGROUND
  The optimal modality of carotid revascularization preceding cardiac surgery is unknown.
  
  
  METHODS
  Retrospective evaluation of the CARE (Carotid Artery Revascularization and Endarterectomy) registry from January 2005 to April 2010 was performed on patients undergoing CEA or CAS preceding urgent cardiac surgery within 30 days. Baseline characteristics were compared, and multivariate adjustment was performed.
  
  
  RESULTS
  Of 451 patients who met study criteria, 255 underwent CAS and 196 underwent CEA. Both procedures increased over time to a similar degree (p = 0.18). Patients undergoing CAS had more frequent history of peripheral artery disease (38.2% vs. 26.5%, p < 0.01), neck surgery (5.5% vs. 1.0%, p = 0.01), neck radiation (4.3% vs. 1.0%, p = 0.04), left-main coronary disease (34.8% vs. 23.5%, p < 0.01), neurological events (45.8% vs. 31.3%, p < 0.01), carotid intervention (20.8% vs. 7.6%, p < 0.01), and higher baseline creatinine (1.3 vs. 1.1 mg/dl, p = 0.02). The target carotid arteries of CAS patients were more likely to be symptomatic in the 6 months before revascularization and have restenosis from prior CEA. Patients undergoing CAS had a lower American Society of Anesthesiology grade. Midwest hospitals were less likely to perform CAS than CEA, whereas in the other regions CAS was more common (p < 0.01). Non-Caucasian race, a history of heart failure, previous carotid procedures, prior stroke, left main coronary artery stenosis, lower American Society of Anesthesiology grade, and teaching hospital were independent predictors of patients who would receive CAS.
  
  
  CONCLUSIONS
  Carotid artery stenting and CEA have increased among patients undergoing urgent cardiac surgery. Patients who underwent CAS had more vascular disease but lower acute pre-surgical risk. Significant regional variation in procedure selection exists.
authors: Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA. cwdon@u.washington.edu
authors: Creighton W
authors: CW
authors: Don
authors: John
authors: J
authors: House
authors: Christopher
authors: C
authors: White
authors: Thomas
authors: T
authors: Kiernan
authors: Mary
authors: M
authors: Weideman
authors: Nicholas
authors: N
authors: Ruggiero
authors: Andrew
authors: A
authors: McCann
authors: Kenneth
authors: K
authors: Rosenfield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D054625:Healthcare Disparities; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012042:Registries; D012111:Residence Characteristics; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States