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A multispecialty consensus-based approach to carotid artery revascularization is feasible in routine clinical practice and results in excellent clinical outcomes
Carotid artery stenting (CAS) and endarterectomy (CEA) are considered competing rather than complementary carotid artery revascularization (CAR) strategies. However, patient characteristics that increase procedural risk are quite different for CAS or CEA. We hypothesized that selecting a CAR strateg...
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| Published in: | The Journal of invasive cardiology 2014-03, Vol.26 (3), p.123-127 |
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| container_end_page | 127 |
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| container_title | The Journal of invasive cardiology |
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| creator | Gupta, Kamal Steffen, Kelly Jo Natarajan, Balasubramanium Biria, Mazda Singh, Vikas Cherian, George |
| description | Carotid artery stenting (CAS) and endarterectomy (CEA) are considered competing rather than complementary carotid artery revascularization (CAR) strategies. However, patient characteristics that increase procedural risk are quite different for CAS or CEA. We hypothesized that selecting a CAR strategy based on individual patient characteristics using a multispecialty consensus based (MSCB) approach will result in superior outcomes in the overall CAR group. We evaluated the feasibility of an MSCB approach to CAR in routine clinical practice.
We performed a retrospective review of patients undergoing CEA or CAS at the Kansas City Veterans hospital over a 2-year period. As routine clinical practice, each case was discussed in a weekly "vascular conference" by vascular surgery, radiology, and interventional cardiology physicians and a revascularization strategy was chosen. Thirty-day and 1-year incidences of stroke, transient ischemic attack, myocardial infarction, and death were recorded.
Eighty CAR procedures were performed (45 CEAs and 35 CASs). The CAS group had an average of 1.9 surgical high-risk features, while the CEA group had 0.5 (P |
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We performed a retrospective review of patients undergoing CEA or CAS at the Kansas City Veterans hospital over a 2-year period. As routine clinical practice, each case was discussed in a weekly "vascular conference" by vascular surgery, radiology, and interventional cardiology physicians and a revascularization strategy was chosen. Thirty-day and 1-year incidences of stroke, transient ischemic attack, myocardial infarction, and death were recorded.
Eighty CAR procedures were performed (45 CEAs and 35 CASs). The CAS group had an average of 1.9 surgical high-risk features, while the CEA group had 0.5 (P<.05). The CAS group had significantly more common carotid stenosis, stenoses considered too high or low for CEA, and more long internal carotid artery lesions. For the overall CAR group, 30-day incidence of stroke/transient ischemic attack, myocardial infarction, and death was 2.5% and 1-year incidence of stroke and death was 5%.
An MSCB approach allows the choice of an optimal CAR strategy with excellent clinical outcomes. Reporting outcomes for the overall CAR may be a better way of assessing and comparing outcomes of CAR across healthcare systems rather than CEA or CAS outcomes separately.</description><identifier>EISSN: 1557-2501</identifier><identifier>PMID: 24610506</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Carotid Artery Diseases - complications ; Carotid Artery Diseases - therapy ; Carotid Stenosis - complications ; Carotid Stenosis - therapy ; Consensus ; Endarterectomy, Carotid ; Feasibility Studies ; Follow-Up Studies ; Humans ; Incidence ; Ischemic Attack, Transient - epidemiology ; Middle Aged ; Myocardial Infarction - epidemiology ; Myocardial Revascularization - methods ; Patient Care Team ; Retrospective Studies ; Stents ; Stroke - epidemiology ; Treatment Outcome</subject><ispartof>The Journal of invasive cardiology, 2014-03, Vol.26 (3), p.123-127</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24610506$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gupta, Kamal</creatorcontrib><creatorcontrib>Steffen, Kelly Jo</creatorcontrib><creatorcontrib>Natarajan, Balasubramanium</creatorcontrib><creatorcontrib>Biria, Mazda</creatorcontrib><creatorcontrib>Singh, Vikas</creatorcontrib><creatorcontrib>Cherian, George</creatorcontrib><title>A multispecialty consensus-based approach to carotid artery revascularization is feasible in routine clinical practice and results in excellent clinical outcomes</title><title>The Journal of invasive cardiology</title><addtitle>J Invasive Cardiol</addtitle><description>Carotid artery stenting (CAS) and endarterectomy (CEA) are considered competing rather than complementary carotid artery revascularization (CAR) strategies. However, patient characteristics that increase procedural risk are quite different for CAS or CEA. We hypothesized that selecting a CAR strategy based on individual patient characteristics using a multispecialty consensus based (MSCB) approach will result in superior outcomes in the overall CAR group. We evaluated the feasibility of an MSCB approach to CAR in routine clinical practice.
We performed a retrospective review of patients undergoing CEA or CAS at the Kansas City Veterans hospital over a 2-year period. As routine clinical practice, each case was discussed in a weekly "vascular conference" by vascular surgery, radiology, and interventional cardiology physicians and a revascularization strategy was chosen. Thirty-day and 1-year incidences of stroke, transient ischemic attack, myocardial infarction, and death were recorded.
Eighty CAR procedures were performed (45 CEAs and 35 CASs). The CAS group had an average of 1.9 surgical high-risk features, while the CEA group had 0.5 (P<.05). The CAS group had significantly more common carotid stenosis, stenoses considered too high or low for CEA, and more long internal carotid artery lesions. For the overall CAR group, 30-day incidence of stroke/transient ischemic attack, myocardial infarction, and death was 2.5% and 1-year incidence of stroke and death was 5%.
An MSCB approach allows the choice of an optimal CAR strategy with excellent clinical outcomes. Reporting outcomes for the overall CAR may be a better way of assessing and comparing outcomes of CAR across healthcare systems rather than CEA or CAS outcomes separately.</description><subject>Aged</subject><subject>Carotid Artery Diseases - complications</subject><subject>Carotid Artery Diseases - therapy</subject><subject>Carotid Stenosis - complications</subject><subject>Carotid Stenosis - therapy</subject><subject>Consensus</subject><subject>Endarterectomy, Carotid</subject><subject>Feasibility Studies</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Incidence</subject><subject>Ischemic Attack, Transient - epidemiology</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Myocardial Revascularization - methods</subject><subject>Patient Care Team</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Stroke - epidemiology</subject><subject>Treatment Outcome</subject><issn>1557-2501</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNpFkE9LxDAQxYsg7rr6FSRHL4WkadLNcVn8Bwte9FyS7BQjaVIzibh-G7-pFVc8DTx-b97MO6mWTIiubgRli-oc8ZXShnHFzqpF00pGBZXL6mtDxuKzwwms0z4fiI0BIWDB2miEPdHTlKK2LyRHYnWK2c1aypAOJMG7Rlu8Tu5TZxcDcUgG0OiMB-ICSbFkF4BY74Kz2pMpaZudBaLDfrbjHI0_IHxY8B5C_kdnq40j4EV1OmiPcHmcq-r59uZpe1_vHu8etptdPTWM5Vpaw9dUQqfU2rZSDEpZQzmnHW-VGYBz1XEhByPNwEFxRmkLglnORNNIZfiquv7dO7_7VgBzPzr8uUoHiAV7NvfVsk7I9YxeHdFiRtj3U3KjTof-r1b-DYTedq4</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Gupta, Kamal</creator><creator>Steffen, Kelly Jo</creator><creator>Natarajan, Balasubramanium</creator><creator>Biria, Mazda</creator><creator>Singh, Vikas</creator><creator>Cherian, George</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20140301</creationdate><title>A multispecialty consensus-based approach to carotid artery revascularization is feasible in routine clinical practice and results in excellent clinical outcomes</title><author>Gupta, Kamal ; Steffen, Kelly Jo ; Natarajan, Balasubramanium ; Biria, Mazda ; Singh, Vikas ; Cherian, George</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p211t-6cb3806e7998c465f99cb03307349bfe3397356fb6bf3e931004e51c3152269b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Carotid Artery Diseases - complications</topic><topic>Carotid Artery Diseases - therapy</topic><topic>Carotid Stenosis - complications</topic><topic>Carotid Stenosis - therapy</topic><topic>Consensus</topic><topic>Endarterectomy, Carotid</topic><topic>Feasibility Studies</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Incidence</topic><topic>Ischemic Attack, Transient - epidemiology</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Myocardial Revascularization - methods</topic><topic>Patient Care Team</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Stroke - epidemiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gupta, Kamal</creatorcontrib><creatorcontrib>Steffen, Kelly Jo</creatorcontrib><creatorcontrib>Natarajan, Balasubramanium</creatorcontrib><creatorcontrib>Biria, Mazda</creatorcontrib><creatorcontrib>Singh, Vikas</creatorcontrib><creatorcontrib>Cherian, George</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of invasive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gupta, Kamal</au><au>Steffen, Kelly Jo</au><au>Natarajan, Balasubramanium</au><au>Biria, Mazda</au><au>Singh, Vikas</au><au>Cherian, George</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A multispecialty consensus-based approach to carotid artery revascularization is feasible in routine clinical practice and results in excellent clinical outcomes</atitle><jtitle>The Journal of invasive cardiology</jtitle><addtitle>J Invasive Cardiol</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>26</volume><issue>3</issue><spage>123</spage><epage>127</epage><pages>123-127</pages><eissn>1557-2501</eissn><abstract>Carotid artery stenting (CAS) and endarterectomy (CEA) are considered competing rather than complementary carotid artery revascularization (CAR) strategies. However, patient characteristics that increase procedural risk are quite different for CAS or CEA. We hypothesized that selecting a CAR strategy based on individual patient characteristics using a multispecialty consensus based (MSCB) approach will result in superior outcomes in the overall CAR group. We evaluated the feasibility of an MSCB approach to CAR in routine clinical practice.
We performed a retrospective review of patients undergoing CEA or CAS at the Kansas City Veterans hospital over a 2-year period. As routine clinical practice, each case was discussed in a weekly "vascular conference" by vascular surgery, radiology, and interventional cardiology physicians and a revascularization strategy was chosen. Thirty-day and 1-year incidences of stroke, transient ischemic attack, myocardial infarction, and death were recorded.
Eighty CAR procedures were performed (45 CEAs and 35 CASs). The CAS group had an average of 1.9 surgical high-risk features, while the CEA group had 0.5 (P<.05). The CAS group had significantly more common carotid stenosis, stenoses considered too high or low for CEA, and more long internal carotid artery lesions. For the overall CAR group, 30-day incidence of stroke/transient ischemic attack, myocardial infarction, and death was 2.5% and 1-year incidence of stroke and death was 5%.
An MSCB approach allows the choice of an optimal CAR strategy with excellent clinical outcomes. Reporting outcomes for the overall CAR may be a better way of assessing and comparing outcomes of CAR across healthcare systems rather than CEA or CAS outcomes separately.</abstract><cop>United States</cop><pmid>24610506</pmid><tpages>5</tpages></addata></record> |
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| identifier | EISSN: 1557-2501 |
| ispartof | The Journal of invasive cardiology, 2014-03, Vol.26 (3), p.123-127 |
| issn | 1557-2501 |
| language | eng |
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| subjects | Aged Carotid Artery Diseases - complications Carotid Artery Diseases - therapy Carotid Stenosis - complications Carotid Stenosis - therapy Consensus Endarterectomy, Carotid Feasibility Studies Follow-Up Studies Humans Incidence Ischemic Attack, Transient - epidemiology Middle Aged Myocardial Infarction - epidemiology Myocardial Revascularization - methods Patient Care Team Retrospective Studies Stents Stroke - epidemiology Treatment Outcome |
| title | A multispecialty consensus-based approach to carotid artery revascularization is feasible in routine clinical practice and results in excellent clinical outcomes |
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