Journal of Vascular Surgery
Volume 49, Issue 2 , Pages 331-339.e1 , February 2009

Outcomes after carotid endarterectomy: Is there a high-risk population? A National Surgical Quality Improvement Program report

Presented at the Annual Meeting of the Society for Vascular Surgery, San Diego, Calif, Jun 5-8, 2008.

  • Jeanwan L. Kang, MD

      Affiliations

    • Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
    • Corresponding Author InformationReprint requests: Jeanwan Kang, MD, Department of Surgery, Massachusetts General Hospital, 55 Fruit St, GRB-425, Boston, MA 02114
    • ,
  • Thomas K. Chung, MA

      Affiliations

    • Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
    • ,
  • Robert T. Lancaster, MD

      Affiliations

    • Ernest Amory Codman Center for Clinical Effectiveness in Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
    • ,
  • Glenn M. LaMuraglia, MD

      Affiliations

    • Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
    • ,
  • Mark F. Conrad, MD

      Affiliations

    • Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
    • ,
  • Richard P. Cambria, MD

      Affiliations

    • Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass

Received 29 June 2008 ,Accepted 11 September 2008.

References 

  1. North American Symptomatic Carotid Endarterectomy Trial Collatorators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–453
  2. Barnett HJ, Taylor W, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. North American Symptomatic Carotid Endarterectomy Trial Collatorators Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med. 1998;339:1415–1425
  3. European Carotid Surgery Trialists' Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351:1379–1387
  4. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–1428
  5. Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, et al. MRC Asymptomatic Carotid Surgery Trial Collaborative Group Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. Lancet. 2004;363:1491–1502
  6. Hobson RW, Weiss DG, Fields WS, Goldstone J, Moore WS, Towne JB, et al. Veterans Affairs Cooperative Study Group Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med. 1993;328:221–227
  7. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy investigators (Protected carotid-artery stenting versus endarterectomy in high-risk patients). N Engl J Med. 2004;351:1493–1501
  8. Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, et al. SAPPHIRE investigators Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008;358:1572–1579
  9. Cambria RP. Stenting for carotid-artery stenosis. N Engl J Med. 2004;351:1565–1567
  10. Thomas DJ. Protected carotid artery stenting versus endarterectomy in high-risk patients: reflections from SAPPHIRE. Stroke. 2005;36:912–913
  11. LoGerfo FW. Carotid stents: unleashed, unproven. Circulation. 2007;116:1596–1601
  12. Samuelson RM, Yamamoto J, Levy EI, Siddiqui AH, Hopkins LN. The argument to support broader application of extracranial carotid artery stent technology. Circulation. 2007;116:1602–1610
  13. Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation. 1998;97:501–509
  14. Stoner MC, Abbott WM, Wong DR, Hua HT, LaMuraglia GM, Kwolek CJ, et al. Defining the high-risk patient for carotid endarterectomy: an analysis of the prospective National Surgical Quality Improvement Program database. J Vasc Surg. 2006;43:285–296
  15. Sidawy AN, Zwolak RM, White RA, Siami FS, Schermerhorn ML, Sicard GA. SVS Carotid Vascular Registry: CAS vs CEA outcomes comparison. 2008;Presented at the Annual Meeting of the SVS, San Diego, Calif, June 4-8,
  16. Timaran CH, Rosero EB, Veith FJ, Clagett JG, Valentine RJ, Smith ST, et al. Intracranial hemorrhage after carotid endarterectomy and carotid artery stenting in the United States in 2005. 2008;Presented at the Annual Meeting of the SVS, San Diego, Calif, June 4-8,
  17. McPhee JT, Hill JS, Ciocca RG, Messina LM, Eslami MH. Carotid endarterectomy was performed with lower stroke and death rates than carotid artery stenting in the United States in 2003 and 2004. J Vasc Surg. 2007;46:1112–1118
  18. Matsen SL, Chang DC, Perler BA, Roseborough GS, Williams GM. Trends in the in-hospital stroke rate following carotid endarterectomy in California and Maryland. J Vasc Surg. 2006;44:488–495
  19. Sheikh K, Bullock C. Variation and changes in state-specific carotid endarterectomy and 30-day mortality rates, United States, 1991-2000. J Vasc Surg. 2003;38:779–784
  20. Kragsterman B, Parsson H, Lindback J, Berggvist D, Bjorck M. Outcomes of carotid endarterectomy for asymptomatic stenosis in Sweden are improving: Results from a population-based registry. J Vasc Surg. 2006;44:79–85
  21. LaMuraglia GM, Brewster DC, Moncure AC, Dorer DJ, Stoner MC, Trehan SK, et al. Carotid endarterectomy at the millennium: what interventional therapy must match. Ann Surg. 2004;240:535–546
  22. Khuri SF, Daley J, Henderson W, Barbour GJ, Lowry P, Irvin G, et al. National Veterans Administration Surgical Risk Study (The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care). J Am Coll Surg. 1995;180:519–531
  23. Fink AS, Campbell DA, Mentzer RM, Henderson WG, Daley J, Bannister J, et al. The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg. 2002;236:344–353
  24. CAVATAS investigators. Endovascular versus surgical treatment in patients with carotid stenosis in the carotid and vertebral artery transluminal angioplasty study (CAVATAS): a radomised trial. Lancet. 2001;357:1729–1737
  25. Alberts MJ. Results of a multicenter prospective randomized trial of carotid artery stenting vs carotid endarterectomy [abstract]. Stroke. 2001;32:325;-d
  26. Ringleb PA, Allenberg J, Bruckmann H, Eckstein HH, Fraedrich G, Hartmann M, et al. SPACE collaborative group 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. 2006;368:1239–1247
  27. Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, et al. EVA-3S investigators Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660–1671
  28. Hobson RW, Howard VJ, Roubin GS, Brott TG, Ferguson RD, Popma JJ, et al. CREST Investigators Carotid artery stenting is associated with increased complications in octogenarians: 30-day stroke and death rates in the CREST lead-in phase. J Vasc Surg. 2004;40:1106–1111
  29. Gray WA, Hopkins LN, Yadav S, Davis T, Wholey M, Atkinson R, et al. ARCHeR trial collaborators Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg. 2006;44:258–269
  30. Iyer SS, White CJ, Hopkins LN, Katzen BT, Safian R, Wholey MH, et al. BEACH investigators Carotid artery revascularization in high-surgical-risk patients using the Carotid WALLSTENT and FilterWire EX/EZ: 1-year outcomes in the BEACH Pivotal Group. J Am Coll Cardiol. 2008;51:427–434
  31. Flanigan DP, Flanigan ME, Dorne AL, Harward TRS, Razavi MK, Ballard JL. Long-term results of 442 consecutive, standardized carotid endarterectomy procedures in standard-risk and high-risk patients. J Vasc Surg. 2007;46:876–882
  32. Mozes G, Sullivan TM, Torres-Russotto DR, Bower TC, Hoskin TL, Sampaio SM, et al. Carotid endarterectomy in SAPPHIRE-eligible high-risk patients: Implications for selecting patients for carotid angioplasty and stenting. J Vasc Surg. 2004;39:958–966
  33. Boules TN, Proctor MC, Aref A, Upchurch GR, Stanley JC, Henke PK. Carotid endarterectomy remains the standard of care, even in high-risk surgical patients. Ann Surg. 2005;241:356–363
  34. Illig KA, Zhang R, Tanski W, Benesch C, Sternbach Y, Green RM. Is the rationale for carotid angioplasty and stenting in patients excluded from NASCET/ACAS or eligible for ARCHeR justified?. J Vasc Surg. 2003;37:575–581
  35. Lepore MR, Sternbergh WC, Salartash K, Tonnessen B, Money SR. Influence of NASCET/ACAS trial eligibility on outcome after carotid endarterectomy. J Vasc Surg. 2001;34:581–586
  36. Miller MT, Comerota AJ, Tzilinis A, Daoud Y, Hammerling J. Carotid endarterectomy in octogenarians: Does increased age indicate “high risk?”. J Vasc Surg. 2005;41:231–237
  37. Sayeed S, Stanziale SF, Wholey MH, Makaroun MS. Angiographic lesion characteristics can predict adverse outcomes after carotid artery stenting. J Vasc Surg. 2008;47:81–87
  38. Lam RC, Lin SC, DeRubertis B, Hynecek R, Kent KC, Faries PL. The impact of increasing age on anatomic factors affectin carotid angioplasty and stenting. J Vasc Surg. 2007;45:875–880
  39. Stanziale SF, Marone LK, Boules TN, Brimmeier JA, Hill K, Makaroun MS, et al. Carotid artery stenting in octogenarians is associated with increased adverse outcomes. J Vasc Surg. 2006;43:297–304
  40. Krejza J, Arkuszewski M, Kasner SE, Weigele J, Ustymowicz A, Hurst RW, et al. Carotid artery diameter in men and women and the relation to body and neck size. Stroke. 2006;37:1103–1105
  41. Messe SR, Kasner SE, Mehta Z, Warlow CP, Rothwell PM European Carotid Surgery Trialists. Effect of body size on operative risk of carotid endarterectomy. J Neurol Neurosurg Psychiatry. 2004;75:1759–1761
  42. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ Carotid Endarterectomy Trialists Collaboration. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet. 2004;363:915–924
  43. Alamowitch S, Eliasziw M, Barnett HJ. The risk and benefit of endarterectomy in women with symptomatic internal carotid artery disease. Stroke. 2005;36:27–31
  44. Rothwell PM, Goldstein LB. Carotid endarterectomy for asymptomatic carotid stenosis: asymptomatic carotid surgery trial. Stroke. 2004;35:2425–2427

 Competition of interest: none.

PII: S0741-5214(08)01602-9

doi: 10.1016/j.jvs.2008.09.018

Journal of Vascular Surgery
Volume 49, Issue 2 , Pages 331-339.e1 , February 2009

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