Peri-procedural Risk with Urgent Carotid Artery Stenting: A Population based Swedvasc Study.
OBJECTIVE
Current European Society for Vascular Surgery guidelines recommend that patients with a symptomatic carotid stenosis should be operated on within 14 days of onset of symptoms. Recent reports indicate that carotid endarterectomy (CEA) within 2 days of a neurological event may be associated with a higher peri-procedural risk of stroke. Whether urgent carotid artery stenting (CAS) carries a similar high risk is unclear. The aim of this study was to analyze if urgent CAS increases the peri-procedural risks.


METHODS
Retrospective analysis of all CAS registered in Swedvasc, a validated nationwide registry, between January 1, 2005, and March 20, 2014. Only symptomatic patients treated for a stenosis of the internal carotid artery were included. Patients were categorized according to time from index event to surgery; 0-2 days, 3-7 days, 8-14 days, and 15-180 days. Primary outcome was 30 day combined stroke and death rate.


RESULTS
323 patients underwent CAS for symptomatic carotid artery stenosis. The demographic and clinical data were similar in the groups. No procedure related complications or deaths were observed in the urgent CAS group. The 30 day combined stroke and death rate did not differ significantly between the groups; zero of 13 (0%; 95% CI 0-26.6) in the group treated 0-2 days versus four of 85 (4.7%; 95% CI 1.5-11.9), at 3-7 days, five of 80 (6.3%; 95% CI 2.4-14.1) at 8-14 days, and six of 145 (4.1%; 95% CI 1.7-8.9) for the patients treated at 15-180 days (p = .757). Stroke and death were not more frequent for patients treated within 1 week compared with after 1 week: 4 out of 98 (4.1%; 95% CI 1.3-9.0) versus 11/225 (4.9%; 95% CI 2.7-8.6) (p = .751).


CONCLUSIONS
In this national registry study, CAS performed within 1 week of the onset of a neurologic event was not associated with an additional risk of a peri-operative complication compared with those treated subsequently.
Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet, 11883 Stockholm, Sweden. Electronic address: magnus.jonsson@sodersjukhuset.se.
M
M
Jonsson
Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet, 11883 Stockholm, Sweden.
P
P
Gillgren
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
A
A
Wanhainen
Vascular Centre, Malmö, Skåne University Hospital, 20502 Malmö, Sweden.
S
S
Acosta
Department of Vascular Surgery, Karolinska University Hospital, Department of Molecular Medicine and Surgery, Karolinska Institutet, 17176 Stockholm, Sweden.
D
D
Lindström
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
Carotid artery stenting; Carotid artery surgery; Carotid stenosis; Stroke; Symptomatic carotid stenosis; Transient ischemic attack