Risk Factors and Angiographic Technical Considerations to Guide Carotid Intervention

Matthew A. Corriere, Jeffery Dattilo, Michael C. Madigan, Raul J. Guzman, Thomas C. Naslund, Marc A. Passman

    Research output: Contribution to journalArticle

    3 Citations (Scopus)

    Abstract

    Carotid angioplasty and stenting (CAS) with embolic protection is currently accepted as treatment for patients considered to be at high risk for carotid endarterectomy (CEA). The purpose of this study was (1) to determine what proportion of patients treated with CEA would be categorized as "high" risk by currently accepted criteria, (2) to characterize preoperative angiographic findings in patients with carotid stenosis, and (3) to determine the potential technical challenges of CAS in these patients. Consecutive patients who underwent CEA from January 1999 through August 2004 prior to introduction of CAS at our institution were identified. Demographics, indications, perioperative complications, and deaths were reviewed. Published guidelines defining high risk for CEA were applied, and preoperative angiograms were examined for technical limitations to CAS. Two hundred and seventy-nine CEAs were performed in 259 patients for asymptomatic carotid occlusive disease (57%), transient ischemic attacks (35%), or stroke (8%) during the study period. Of these, 35.5% (n = 99) would have met one or more high-risk criteria. Overall risks of perioperative stroke, myocardial infarction, and death were 1.1%, 2.2%, and 0.4% (n = 279), respectively, with a combined major complication rate of 3.3%. No difference in major complication rates was observed between standard-risk and high-risk patients. Preoperative angiograms were available for review in 83.5% of CEAs (n = 233). The distribution of aortic arch configurations included types I (3.5%), IIa (39.5%), IIb (54.5%), and III (1.3%). Aortic arch anomalies were observed in 15.5% (n = 35) of angiograms. There were 77.7% (n = 181) with one or more angiographic findings that would have increased the technical difficulty of CAS, but only 17.6% had relative angiographic contraindications to CAS. A significant proportion of patients with carotid stenosis previously managed with CEA would be categorized as high risk and considered potential candidates for CAS by currently accepted criteria. Based on preoperative angiography, technically challenging factors, some of which limit the ability to perform CAS, are common and should be anticipated when planning CAS.

    Original languageEnglish (US)
    Pages (from-to)52-57
    Number of pages6
    JournalAnnals of Vascular Surgery
    Volume22
    Issue number1
    DOIs
    StatePublished - Jan 1 2008

    Fingerprint

    Angioplasty
    Carotid Endarterectomy
    Angiography
    Carotid Stenosis
    Thoracic Aorta
    Stroke
    Transient Ischemic Attack
    Myocardial Infarction
    Demography
    Guidelines

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Corriere, M. A., Dattilo, J., Madigan, M. C., Guzman, R. J., Naslund, T. C., & Passman, M. A. (2008). Risk Factors and Angiographic Technical Considerations to Guide Carotid Intervention. Annals of Vascular Surgery, 22(1), 52-57. https://doi.org/10.1016/j.avsg.2007.07.033

    Risk Factors and Angiographic Technical Considerations to Guide Carotid Intervention. / Corriere, Matthew A.; Dattilo, Jeffery; Madigan, Michael C.; Guzman, Raul J.; Naslund, Thomas C.; Passman, Marc A.

    In: Annals of Vascular Surgery, Vol. 22, No. 1, 01.01.2008, p. 52-57.

    Research output: Contribution to journalArticle

    Corriere, MA, Dattilo, J, Madigan, MC, Guzman, RJ, Naslund, TC & Passman, MA 2008, 'Risk Factors and Angiographic Technical Considerations to Guide Carotid Intervention', Annals of Vascular Surgery, vol. 22, no. 1, pp. 52-57. https://doi.org/10.1016/j.avsg.2007.07.033
    Corriere, Matthew A. ; Dattilo, Jeffery ; Madigan, Michael C. ; Guzman, Raul J. ; Naslund, Thomas C. ; Passman, Marc A. / Risk Factors and Angiographic Technical Considerations to Guide Carotid Intervention. In: Annals of Vascular Surgery. 2008 ; Vol. 22, No. 1. pp. 52-57.
    @article{38c28cba930b47528cb44191f2ae5d6e,
    title = "Risk Factors and Angiographic Technical Considerations to Guide Carotid Intervention",
    abstract = "Carotid angioplasty and stenting (CAS) with embolic protection is currently accepted as treatment for patients considered to be at high risk for carotid endarterectomy (CEA). The purpose of this study was (1) to determine what proportion of patients treated with CEA would be categorized as {"}high{"} risk by currently accepted criteria, (2) to characterize preoperative angiographic findings in patients with carotid stenosis, and (3) to determine the potential technical challenges of CAS in these patients. Consecutive patients who underwent CEA from January 1999 through August 2004 prior to introduction of CAS at our institution were identified. Demographics, indications, perioperative complications, and deaths were reviewed. Published guidelines defining high risk for CEA were applied, and preoperative angiograms were examined for technical limitations to CAS. Two hundred and seventy-nine CEAs were performed in 259 patients for asymptomatic carotid occlusive disease (57{\%}), transient ischemic attacks (35{\%}), or stroke (8{\%}) during the study period. Of these, 35.5{\%} (n = 99) would have met one or more high-risk criteria. Overall risks of perioperative stroke, myocardial infarction, and death were 1.1{\%}, 2.2{\%}, and 0.4{\%} (n = 279), respectively, with a combined major complication rate of 3.3{\%}. No difference in major complication rates was observed between standard-risk and high-risk patients. Preoperative angiograms were available for review in 83.5{\%} of CEAs (n = 233). The distribution of aortic arch configurations included types I (3.5{\%}), IIa (39.5{\%}), IIb (54.5{\%}), and III (1.3{\%}). Aortic arch anomalies were observed in 15.5{\%} (n = 35) of angiograms. There were 77.7{\%} (n = 181) with one or more angiographic findings that would have increased the technical difficulty of CAS, but only 17.6{\%} had relative angiographic contraindications to CAS. A significant proportion of patients with carotid stenosis previously managed with CEA would be categorized as high risk and considered potential candidates for CAS by currently accepted criteria. Based on preoperative angiography, technically challenging factors, some of which limit the ability to perform CAS, are common and should be anticipated when planning CAS.",
    author = "Corriere, {Matthew A.} and Jeffery Dattilo and Madigan, {Michael C.} and Guzman, {Raul J.} and Naslund, {Thomas C.} and Passman, {Marc A.}",
    year = "2008",
    month = "1",
    day = "1",
    doi = "10.1016/j.avsg.2007.07.033",
    language = "English (US)",
    volume = "22",
    pages = "52--57",
    journal = "Annals of Vascular Surgery",
    issn = "0890-5096",
    publisher = "Elsevier Inc.",
    number = "1",

    }

    TY - JOUR

    T1 - Risk Factors and Angiographic Technical Considerations to Guide Carotid Intervention

    AU - Corriere, Matthew A.

    AU - Dattilo, Jeffery

    AU - Madigan, Michael C.

    AU - Guzman, Raul J.

    AU - Naslund, Thomas C.

    AU - Passman, Marc A.

    PY - 2008/1/1

    Y1 - 2008/1/1

    N2 - Carotid angioplasty and stenting (CAS) with embolic protection is currently accepted as treatment for patients considered to be at high risk for carotid endarterectomy (CEA). The purpose of this study was (1) to determine what proportion of patients treated with CEA would be categorized as "high" risk by currently accepted criteria, (2) to characterize preoperative angiographic findings in patients with carotid stenosis, and (3) to determine the potential technical challenges of CAS in these patients. Consecutive patients who underwent CEA from January 1999 through August 2004 prior to introduction of CAS at our institution were identified. Demographics, indications, perioperative complications, and deaths were reviewed. Published guidelines defining high risk for CEA were applied, and preoperative angiograms were examined for technical limitations to CAS. Two hundred and seventy-nine CEAs were performed in 259 patients for asymptomatic carotid occlusive disease (57%), transient ischemic attacks (35%), or stroke (8%) during the study period. Of these, 35.5% (n = 99) would have met one or more high-risk criteria. Overall risks of perioperative stroke, myocardial infarction, and death were 1.1%, 2.2%, and 0.4% (n = 279), respectively, with a combined major complication rate of 3.3%. No difference in major complication rates was observed between standard-risk and high-risk patients. Preoperative angiograms were available for review in 83.5% of CEAs (n = 233). The distribution of aortic arch configurations included types I (3.5%), IIa (39.5%), IIb (54.5%), and III (1.3%). Aortic arch anomalies were observed in 15.5% (n = 35) of angiograms. There were 77.7% (n = 181) with one or more angiographic findings that would have increased the technical difficulty of CAS, but only 17.6% had relative angiographic contraindications to CAS. A significant proportion of patients with carotid stenosis previously managed with CEA would be categorized as high risk and considered potential candidates for CAS by currently accepted criteria. Based on preoperative angiography, technically challenging factors, some of which limit the ability to perform CAS, are common and should be anticipated when planning CAS.

    AB - Carotid angioplasty and stenting (CAS) with embolic protection is currently accepted as treatment for patients considered to be at high risk for carotid endarterectomy (CEA). The purpose of this study was (1) to determine what proportion of patients treated with CEA would be categorized as "high" risk by currently accepted criteria, (2) to characterize preoperative angiographic findings in patients with carotid stenosis, and (3) to determine the potential technical challenges of CAS in these patients. Consecutive patients who underwent CEA from January 1999 through August 2004 prior to introduction of CAS at our institution were identified. Demographics, indications, perioperative complications, and deaths were reviewed. Published guidelines defining high risk for CEA were applied, and preoperative angiograms were examined for technical limitations to CAS. Two hundred and seventy-nine CEAs were performed in 259 patients for asymptomatic carotid occlusive disease (57%), transient ischemic attacks (35%), or stroke (8%) during the study period. Of these, 35.5% (n = 99) would have met one or more high-risk criteria. Overall risks of perioperative stroke, myocardial infarction, and death were 1.1%, 2.2%, and 0.4% (n = 279), respectively, with a combined major complication rate of 3.3%. No difference in major complication rates was observed between standard-risk and high-risk patients. Preoperative angiograms were available for review in 83.5% of CEAs (n = 233). The distribution of aortic arch configurations included types I (3.5%), IIa (39.5%), IIb (54.5%), and III (1.3%). Aortic arch anomalies were observed in 15.5% (n = 35) of angiograms. There were 77.7% (n = 181) with one or more angiographic findings that would have increased the technical difficulty of CAS, but only 17.6% had relative angiographic contraindications to CAS. A significant proportion of patients with carotid stenosis previously managed with CEA would be categorized as high risk and considered potential candidates for CAS by currently accepted criteria. Based on preoperative angiography, technically challenging factors, some of which limit the ability to perform CAS, are common and should be anticipated when planning CAS.

    UR - http://www.scopus.com/inward/record.url?scp=37749051813&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=37749051813&partnerID=8YFLogxK

    U2 - 10.1016/j.avsg.2007.07.033

    DO - 10.1016/j.avsg.2007.07.033

    M3 - Article

    VL - 22

    SP - 52

    EP - 57

    JO - Annals of Vascular Surgery

    JF - Annals of Vascular Surgery

    SN - 0890-5096

    IS - 1

    ER -