Author + information
- Received November 2, 2010
- Revision received September 19, 2011
- Accepted September 19, 2011
- Published online November 1, 2011.
- Creighton W. Don, MD, PhD⁎,⁎ (, )
- John House, MS†,
- Christopher White, MD‡,
- Thomas Kiernan, MD∥,
- Mary Weideman, MS§,
- Nicholas Ruggiero, MD¶,
- Andrew McCann, MD# and
- Kenneth Rosenfield, MD⁎⁎
- ↵⁎Reprint requests and correspondence:
Dr. Creighton W. Don, University of Washington Medical Center, Medicine–Division of Cardiology, 1959 Northeast Pacific Street, Seattle, Washington 98195
Objectives We describe characteristics associated with use of endarterectomy (CEA) versus stenting (CAS) in patients before urgent cardiac surgery.
Background The optimal modality of carotid revascularization preceding cardiac surgery is unknown.
Methods Retrospective evaluation of the CARE (Carotid Artery Revascularization and Endarterectomy) registry from January 2005 to April 2010 was performed on patients undergoing CEA or CAS preceding urgent cardiac surgery within 30 days. Baseline characteristics were compared, and multivariate adjustment was performed.
Results Of 451 patients who met study criteria, 255 underwent CAS and 196 underwent CEA. Both procedures increased over time to a similar degree (p = 0.18). Patients undergoing CAS had more frequent history of peripheral artery disease (38.2% vs. 26.5%, p < 0.01), neck surgery (5.5% vs. 1.0%, p = 0.01), neck radiation (4.3% vs. 1.0%, p = 0.04), left-main coronary disease (34.8% vs. 23.5%, p < 0.01), neurological events (45.8% vs. 31.3%, p < 0.01), carotid intervention (20.8% vs. 7.6%, p < 0.01), and higher baseline creatinine (1.3 vs. 1.1 mg/dl, p = 0.02). The target carotid arteries of CAS patients were more likely to be symptomatic in the 6 months before revascularization and have restenosis from prior CEA. Patients undergoing CAS had a lower American Society of Anesthesiology grade. Midwest hospitals were less likely to perform CAS than CEA, whereas in the other regions CAS was more common (p < 0.01). Non-Caucasian race, a history of heart failure, previous carotid procedures, prior stroke, left main coronary artery stenosis, lower American Society of Anesthesiology grade, and teaching hospital were independent predictors of patients who would receive CAS.
Conclusions Carotid artery stenting and CEA have increased among patients undergoing urgent cardiac surgery. Patients who underwent CAS had more vascular disease but lower acute pre-surgical risk. Significant regional variation in procedure selection exists.
This study was funded under NCRR Grant 5 KL2 RR025015. Dr. Rosenfield is a consultant for Abbott Vascular; has received royalty for Angioguard from Cordis; and has received research support from Abbott Vascular, Lutonix, Atrium, and IDEV. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. George W. Vetrovec, MD, has served as Guest Editor for this paper.
- Received November 2, 2010.
- Revision received September 19, 2011.
- Accepted September 19, 2011.
- American College of Cardiology Foundation