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- W2749205822 abstract "Intracranial hemorrhage (ICH) associated with cerebral hyperperfusion syndrome is a rare but major complication of carotid artery revascularization. The objective of this study was to compare the rates of ICH after carotid artery stenting (CAS) vs carotid endarterectomy (CEA). This was a retrospective population-based cohort study of patients who underwent carotid revascularization in Ontario between 2002 and 2015. Our primary outcome was 90-day ICH among patients who underwent CAS vs CEA. We used inverse probability of treatment weighting using propensity scores to adjust for selection bias. In sensitivity analyses, we excluded patients who had postprocedure ischemic stroke and examined a subgroup of patients ≥66 years old to account for baseline medication use. A total of 16,688 patients underwent carotid revascularization (14% CAS; 86% CEA). Patients with more comorbid illnesses, symptomatic carotid stenosis, or cardiac disease and taking antiplatelets or warfarin preoperatively were more likely to undergo CAS. Among the overall cohort, 80 (0.48%) patients developed ICH within 90 days. The 180-day mortality after ICH was 42.5%, which was considerably higher than the 180-day mortality rate of the overall cohort (2.7%). In the adjusted analysis, CAS patients were more likely to have ICH compared with CEA patients (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.32-2.36; P < .001). These results were consistent after excluding patients who developed postprocedure ischemic strokes (adjusted OR, 1.90; 95% CI, 1.41-2.56); among the subgroup of patients ≥66 years old (adjusted OR, 1.53; 95% CI, 1.05-2.24); and among symptomatic (adjusted OR, 1.74; 95% CI, 1.16-2.63) and asymptomatic (adjusted OR, 1.75; 95% CI, 1.16-2.63) carotid stenosis patients. CAS is associated with rare but higher risk of ICH relative to CEA. Future research is needed to devise strategies that minimize the risk of this serious complication after CAS." @default.
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- W2749205822 date "2017-09-01" @default.
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- W2749205822 title "Risk of Intracranial Hemorrhage After Carotid Endarterectomy Versus Stenting" @default.
- W2749205822 doi "https://doi.org/10.1016/j.jvs.2017.07.032" @default.
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