Editor's Choice - Effect of More Expedited Carotid Intervention on Recurrent Ischaemic Event Rate: A National Audit

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Kragsterman, BjörnUppsala universitet,Kärlkirurgi (författare)

Editor's Choice - Effect of More Expedited Carotid Intervention on Recurrent Ischaemic Event Rate: A National Audit

Artikel/kapitelEngelska2018

Förlag, utgivningsår, omfång ...

Elsevier BV,2018

Nummerbeteckningar

LIBRIS-ID:oai:gup.ub.gu.se/272175
https://gup.ub.gu.se/publication/272175URI
https://doi.org/10.1016/j.ejvs.2018.06.036DOI
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-367398URI
http://kipublications.ki.se/Default.aspx?queryparsed=id:139320473URI

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Språk:engelska

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Anmärkningar

Background: The benefit of carotid endarterectomy (CEA) or stenting (CAS) for symptomatic stenosis depends on the timing in relation to the presenting event. As the risk of recurrent events is highest in the early phase, guidelines recommend a short delay. The purpose of this national audit was to study the effects of more expedient carotid intervention on the risk of recurrent ischaemic events. Methods: Data on all CEA and CAS for symptomatic stenosis, including both recurrent ischaemic events during the waiting time to carotid intervention and peri-operative 30 day complication rates, were obtained from the Swedish Vascular Registry between May 2008 and December 2015. The National Prescribed Drug Registry provided data on preventive medication prior to hospitalisation with the presenting event. The primary endpoint was a recurrent cerebral ischaemic event occurring after the presenting event up to 30 days of post-operative follow up. Results: A total of 6814 procedures for symptomatic carotid stenosis were studied. The proportion of recurrent ischaemic events, meaning all secondary events occurring after the presenting event up to 30 days follow up with inclusion of all pre- and post-intervention recurrences was recorded. These recurrent events decreased over time, from 31% in 2008-2009 to 21% in 2014-2015 (p < .01, chi-square test). In parallel, the median waiting time for carotid intervention decreased from 13 (IQR 6-27) to 7 days (IQR 4-12). Baseline demographic variables and comorbidities were similar during the study period. The proportion of pre-operative recurrences were reduced from 25% to 18% (p < .01, chi-square test) while the peri-operative stroke and/or death rate was 3.6%, and improved slightly during the study. Conclusions: A substantial reduction in the secondary ischaemic event rate was observed when the median waiting time for CEA/CAS was reduced, and this was not counterbalanced by any increase in the peri-operative complication rate. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
Carotid artery stenosis
Carotid endarterectomy
Carotid artery stenting
Stroke
Transient ischaemic attack
increased procedural risk
acute minor stroke
swedvasc registry
artery
stenosis
endarterectomy
surgery
attack
delay
time
clopidogrel
Surgery
Cardiovascular System & Cardiology
Carotid artery stenosis

Biuppslag (personer, institutioner, konferenser, titlar ...)

Nordanstig, Annika,1974Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi,Institute of Neuroscience and Physiology,Gothenburg Univ, Sahlgrenska Univ Hosp & Acad, Dept Neurol, Gothenburg, Sweden(Swepub:gu)xnoraz (författare)
Lindstrom, D.Karolinska Institutet (författare)
Strömberg, SofiaGothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine,Gothenburg Univ, Sahlgrenska Univ Hosp & Acad, Dept Vasc Surg, Gothenburg, Sweden(Swepub:gu)xstrso (författare)
Thuresson, M.Statisticon AB, Uppsala, Sweden;Swedenburg Univ, Gothenburg, Sweden (författare)
Nordanstig, JoakimGothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine,Gothenburg Univ, Sahlgrenska Univ Hosp & Acad, Dept Vasc Surg, Gothenburg, Sweden(Swepub:gu)xnjoak (författare)
Uppsala universitetKärlkirurgi (creator_code:org_t)

Sammanhörande titlar

Ingår i:European Journal of Vascular and Endovascular Surgery: Elsevier BV56:4, s. 467-4741078-58841532-2165

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Av författaren/redakt...: Kragsterman, Bjö ...; Nordanstig, Anni ...; Lindstrom, D.; Strömberg, Sofia; Thuresson, M.; Nordanstig, Joak ...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

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Av lärosätet: Göteborgs universitet; Uppsala universitet; Karolinska Institutet

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