title: Preoperative symptom type influences the 30-day perioperative outcomes of carotid endarterectomy and carotid stenting in the Society for Vascular Surgery Vascular Registry.
abstract: OBJECTIVE
  The objective of this study was to determine the effect of presenting symptom types on 30-day periprocedural outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in contemporary vascular practice.
  
  
  METHODS
  Retrospective review was undertaken of the Society for Vascular Surgery Vascular Registry database subjects who underwent CEA or CAS from 2004 to 2011. Patients were grouped by discrete 12-month preprocedural ipsilateral symptom type: stroke, transient ischemic attack (TIA), transient monocular blindness (TMB), or asymptomatic (ASX). Risk-adjusted odds ratios (ORs) were used to compare the likelihood of the 30-day outcomes of death, stroke, and myocardial infarction (MI) and the composite outcomes of death + stroke and death + stroke + MI.
  
  
  RESULTS
  Symptom type significantly influences risk-adjusted 30-day outcomes for carotid intervention. Presentation with stroke predicted the poorest outcomes (death + stroke + MI composite: OR, 1.3; 95% confidence interval [CI], 0.83-2.03 vs TIA; OR, 2.56; 95% CI, 1.18-5.57 vs TMB; OR, 2.12; 95% CI, 1.46-3.08 vs ASX), followed by TIA (death + stroke + MI composite: OR, 1.97; 95% CI, 0.91-4.25 vs TMB; OR, 1.63; 95% CI, 1.14-2.33 vs ASX). For both CAS and CEA patients, presentation with stroke or TIA predicted a higher risk of periprocedural stroke than in ASX patients. Presentation with stroke predicted higher 30-day risk of death with CAS but not with CEA. MI rates were not affected by presenting symptom type. The 30-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 both CAS and CEA in contemporary vascular surgical practice. Presentation with stroke and TIA predicts higher rates of periprocedural complications, whereas TMB presentation predicts a periprocedural risk profile similar to that of ASX disease.
authors.affiliation: Division of Surgery, Vascular Surgery Section, Washington University Medical School, St. Louis, Mo.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Geraghty
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Brothers
authors.affiliation: Southcoast Cardiovascular Surgery, Southcoast Health System, Fall River, Mass.
authors.forename: David L
authors.initials: DL
authors.lastname: Gillespie
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Virginia Medical School, Charlottesville, Va.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.affiliation: Department of Cardiovascular Sciences, Vascular Surgery, East Carolina University, Greenville, NC.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stoner
authors.affiliation: New England Research Institutes, Inc, Watertown, Mass. Electronic address: ssiami@neriscience.com.
authors.forename: Flora S
authors.initials: FS
authors.lastname: Siami
authors.affiliation: New England Research Institutes, Inc, Watertown, Mass.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Kenwood
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020757:Amaurosis Fugax / Q000209:etiology; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States