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Clinical features and outcomes of carotid artery stenting by clinical expert consensus criteria: a report from the CARE registry.
- Source :
-
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2010 Mar 01; Vol. 75 (4), pp. 519-25. - Publication Year :
- 2010
-
Abstract
- Background: In 2007, a multispecialty society task force published a clinical expert consensus document (CECD) on carotid stenting (CAS), containing recommendations for appropriate patient selection and quality of care. The CECD also inspired creation of a large, national registry of carotid revascularization, the Carotid Artery Revascularization and Endarterectomy (CARE) registry. Our goal here was to investigate whether initial CAS procedures submitted to CARE conformed to CECD recommendations, and examine their clinical outcomes.<br />Methods: We analyzed CAS procedures for the period January 1, 2005 through December 31, 2008. These were grouped into those that conformed to CECD recommendations [CECD(+), n = 4,636, 79.8%] and those that did not [CECD(-), n = 1,168, 20.2%].<br />Results: The CECD(+) patients were older than CECD(-) patients (71.5 +/- 10.3 vs. 67.6 +/- 10.3 years, P = 0.001, respectively), and more frequently had chronic kidney disease (46.9% vs. 17.8%, P = 0.001), chronic lung disease (33.0% vs. 12.4%, P = 0.001), ejection fraction <or= 0.30 (13.5% vs. 5.5%, P = 0.001) and contralateral carotid artery occlusion (12.7% vs. 4.6%, P = 0.001). Clinical outcomes at 30 days were similar, including death (1.24% vs. 0.76%, P = 0.184), stroke (5.32% vs. 5.34%, P = 0.954), and death, stroke, or MI (7.04% vs. 6.95%, P = 0.944).<br />Conclusions: Most CAS procedures submitted to CARE conformed to CECD recommendations for patient selection. For reported data, clinical outcomes at 30 days were similar for procedures meeting and those not meeting recommendations, and were similar to outcomes reported by other large registries. These findings suggest that acceptable patient selection criteria for CAS are employed as it expands beyond investigators into more widespread clinical practice.
- Subjects :
- Aged
Aged, 80 and over
Angioplasty adverse effects
Angioplasty mortality
Carotid Stenosis complications
Carotid Stenosis diagnosis
Carotid Stenosis mortality
Chi-Square Distribution
Endarterectomy, Carotid
Evidence-Based Medicine
Guideline Adherence
Humans
Kaplan-Meier Estimate
Middle Aged
Patient Selection
Practice Guidelines as Topic
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke etiology
Time Factors
Treatment Outcome
United States
Angioplasty instrumentation
Carotid Stenosis therapy
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1522-726X
- Volume :
- 75
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
- Publication Type :
- Academic Journal
- Accession number :
- 20088016
- Full Text :
- https://doi.org/10.1002/ccd.22333