부산대학교 도서관

Introduction: Contralateral carotid occlusion (CCO) is an established high-risk feature for carotid endarterectomy (CEA) and is a reason to recommend carotid artery stenting (CAS). Recent observational data have called into question whether CCO remains a high-risk feature for CEA. We investigated the clinical impact of CCO among patients undergoing CEA and CAS in a contemporary nationwide registry.Hypothesis: CCO confers an elevated risk of in-hospital adverse events among patients undergoing CEA, but not CAS.Methods: All patients undergoing CEA or CAS from 2005-2019 in the NCDR CARE and PVI registries were included. The primary exposure was the presence of a CCO. The outcome was a composite of in-hospital death, stroke, and myocardial infarction. Analyses were stratified by treatment with CEA or CAS. Multivariable logistic regression models were used to identify factors associated with adverse outcomes.Results: Among 58,423 patients, 4,624 (7.9%) patients had a CCO. Of those, 68.9% (N=3,185) underwent CAS and 31.1% (N=1,439) underwent CEA. The average age of patients with CCO was 69.5±9.7, 32.6% were female, 92.8% were Caucasian, 51.7% had a prior TIA or stroke, and 45.4% had symptomatic disease. Over the study period, there was a 4.3% decline in procedures performed on patients with CCO (p <0.001), but CAS remained the primary revascularization strategy (7.8% CAS vs 3.5% CEA in 2019Q2). Unadjusted rates of the composite outcome were lower after CAS (3.2%) than after CEA (3.9%). Following adjustment, CCO was associated with a 60% increase in odds of an adverse outcome after CEA (95%CI 1.2-2.12, p=0.0013) (Figure). There was no increase in risk for patients treated with CAS (adjusted OR 0.99, 95%CI 0.79-1.22, p=0.89).Conclusions: In this contemporary nationwide registry analysis, CCO remains an important predictor of increased risk in patients undergoing CEA, but not CAS. These data support the continued use of CCO to guide carotid revascularization strategy.