Determinants of Pre- and Post-Procedural Neurological Assessment, and Outcome of Carotid Endarterectomy or Stenting
Abstract
:1. Introduction
2. Methods
2.1. Data Source
2.2. Case Selection and Grouping
2.3. Study Outcomes
2.4. Statistical Analyses
3. Results
3.1. Baseline Characteristics of Patients
3.2. Perioperative Management and Treatment
3.3. Neurological Assessment by Indication for Treatment
3.4. Hospital and Regional Characteristics (Bavarian Data Only)
3.5. Neurological Assessment by Outcome
3.6. Multivariable Regression Analysis of Determinants of Pre-NA and Post-NA
3.7. Multivariate Regression Analysis of Factors Associated with POE
4. Discussion
Limitations and Strengths
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Overall (Column-%) | Pre-Operative Neurological Assessment | Post-Operative Neurological Assessment | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Yes | No | Yes | No | |||||||
No. of cases (%) | 228,133 | (100) | 165,459 | (72.5) | 62,674 | (27.5) | 14,2619 | (62.5) | 85,514 | (37.5) |
Age (M, Q1/3) | 72 | (65–78) | 72 | (64–78) | 72 | (65–77) | 72 | (64–78) | 72 | (65–77) |
Male sex | 155,532 | (68) | 113,045 | (72.7) | 42,487 | (27.3) | 97,280 | (62.5) | 58,252 | (37.5) |
Side of treatment (right) | 114,427 | (50) | 82,454 | (72.1) | 31,973 | (27.9) | 70,950 | (62.0) | 43,477 | (38.0) |
ASA stage | ||||||||||
Stage I+II | 73,744 | (33) | 53,269 | (72.2) | 20,475 | (27.8) | 46,521 | (63.1) | 27,223 | (36.9) |
Stage III | 144,104 | (64) | 104,015 | (72.2) | 40,089 | (27.8) | 88,751 | (61.6) | 55,353 | (38.4) |
Stage IV+V | 8161 | (4) | 6563 | (80.4) | 1598 | (19.6) | 5932 | (72.7) | 2229 | (27.3) |
Ipsilateral degree of stenosis ° | ||||||||||
Mild (<50%) | 4076 | (2) | 2723 | (66.8) | 1353 | (33.2) | 2488 | (61.0) | 1588 | (39.0) |
Moderate (50–69%) | 11,715 | (5) | 9543 | (81.5) | 2172 | (18.5) | 7803 | (66.6) | 3912 | (33.4) |
Severe (70–99%) | 208,265 | (91) | 149,515 | (71.8) | 58,750 | (28.2) | 128,794 | (61.8) | 79,471 | (38.2) |
Occlusion (100%) | 4077 | (2) | 3678 | (90.2) | 399 | (9.8) | 3534 | (86.7) | 543 | (13.3) |
Contralateral degree of stenosis ° | ||||||||||
Mild (<50%) | 155,231 | (68) | 112,612 | (72.5) | 42,619 | (27.5) | 97,587 | (62.9) | 57,644 | (37.1) |
Moderate (50–69%) | 31,375 | (14) | 22,370 | (71.3) | 9005 | (28.7) | 18,815 | (60.0) | 12,560 | (40.0) |
Severe (70–99%) | 27,159 | (12) | 19,593 | (72.1) | 7566 | (27.9) | 16,851 | (62.0) | 10,308 | (38.0) |
Occlusion (100%) | 14,368 | (6) | 10,884 | (75.8) | 3484 | (24.2) | 9366 | (65.2) | 5002 | (34.8) |
Neurological symptoms & | ||||||||||
Asymptomatic (A) | 122,363 | (59) | 73,425 | (60.0) | 48,938 | (40.0) | 66,580 | (54.4) | 55,783 | (45.6) |
Amaurosis fugax (B) | 12,375 | (6) | 9854 | (79.6) | 2521 | (20.4) | 7937 | (64.1) | 4438 | (35.9) |
Transitory ischemic attack (B) | 23,257 | (11) | 20,422 | (87.8) | 2835 | (12.2) | 15,933 | (68.5) | 7324 | (31.5) |
Any stroke (B) | 18,787 | (9) | 17,659 | (94.0) | 1128 | (6.0) | 13,910 | (74.0) | 4877 | (26.0) |
SIE or crescendo-TIA (C1) | 9962 | (5) | 9206 | (92.4) | 756 | (7.6) | 8289 | (83.2) | 1673 | (16.8) |
Simultaneous operations (C2) | 6851 | (3) | 4390 | (64.1) | 2461 | (35.9) | 4063 | (59.3) | 2788 | (40.7) |
Other symptoms (B + C3) | 13,754 | (7) | 10,812 | (78.6) | 2942 | (21.4) | 9317 | (67.7) | 4437 | (32.3) |
Morphological characteristics | ||||||||||
Ulcerated plaque | 22,630 | (10) | 17,732 | (78.4) | 4898 | (21.6) | 14,654 | (64.8) | 7976 | (35.2) |
Aneurysm | 1418 | (1) | 1023 | (72.1) | 395 | (27.9) | 927 | (65.4) | 491 | (34.6) |
Coiling | 1648 | (1) | 1333 | (80.9) | 315 | (19.1) | 1094 | (66.4) | 554 | (33.6) |
Multiple lesions | 6354 | (3) | 5213 | (82.0) | 1141 | (18.0) | 4638 | (73.0) | 1716 | (27.0) |
Others | 7770 | (3) | 5761 | (74.1) | 2009 | (25.9) | 5147 | (66.2) | 2623 | (33.8) |
Overall (Column-%) | Pre-Operative Neurological Assessment | Post-Operative Neurological Assessment | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Yes | No | Yes | No | |||||||
Time interval from symptom onset | ||||||||||
0–2 days | 8273 | (11) | 7453 | (90.1) | 820 | (9.9) | 6456 | (78.0) | 1817 | (22.0) |
3–7 days | 27,597 | (38) | 25,465 | (92.3) | 2132 | (7.7) | 20,555 | (74.5) | 7042 | (25.5) |
8–14 days | 15,333 | (21) | 13,909 | (90.7) | 1424 | (9.3) | 11,017 | (71.9) | 4316 | (28.1) |
15–180 days | 22,316 | (30) | 18,228 | (81.7) | 4088 | (18.3) | 13,903 | (62.3) | 8413 | (37.7) |
Day of week (admission) | ||||||||||
Monday | 58,066 | (25) | 40,450 | (69.7) | 17,616 | (30.3) | 35,355 | (60.9) | 22,711 | (39.1) |
Tuesday | 48,287 | (21) | 34,656 | (71.8) | 13,631 | (28.2) | 30,047 | (62.2) | 18,240 | (37.8) |
Wednesday | 45,356 | (20) | 31,797 | (70.1) | 13,559 | (29.9) | 27,334 | (60.3) | 18,022 | (39.7) |
Thursday | 35,653 | (16) | 25,773 | (72.3) | 9880 | (27.7) | 21,872 | (61.3) | 13,781 | (38.7) |
Friday | 17,575 | (8) | 14,470 | (82.3) | 3105 | (17.7) | 12,228 | (69.6) | 5347 | (30.4) |
Saturday | 7125 | (3) | 6512 | (91.4) | 613 | (8.6) | 5672 | (79.6) | 1453 | (20.4) |
Sunday | 16,071 | (7) | 11,801 | (73.4) | 4270 | (26.6) | 10,111 | (62.9) | 5960 | (37.1) |
Preoperative diagnostics | ||||||||||
Duplex ultrasound | 156,306 | (69) | 110,954 | (71.0) | 45,352 | (29.0) | 93,828 | (60.0) | 62,478 | (40.0) |
Transcranial Doppler | 46,925 | (21) | 43,789 | (93.3) | 3136 | (6.7) | 36,454 | (77.7) | 10,471 | (22.3) |
CTA | 86,184 | (38) | 68,688 | (79.7) | 17,496 | (20.3) | 56,993 | (66.1) | 29,191 | (33.9) |
MRA | 76,551 | (34) | 56,274 | (73.5) | 20,277 | (26.5) | 47,351 | (61.9) | 29,200 | (38.1) |
Overall (Column-%) | Pre-Operative Neurological Assessment | Post-Operative Neurological Assessment | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Yes | No | Yes | No | |||||||
Asymptomatic (A) | ||||||||||
CEA | 100,915 | (82) | 58,163 | (57.6) | 42,752 | (42.4) | 53,286 | (52.8) | 47,629 | (47.2) |
CAS | 21,448 | (18) | 15,262 | (71.2) | 6186 | (28.2) | 13,294 | (62.0) | 8154 | (38.0) |
Symptomatic (elective, B) | ||||||||||
CEA | 65,852 | (83) | 58,356 | (88.6) | 7496 | (11.4) | 45,526 | (69.1) | 20,326 | (30.9) |
CAS | 13,115 | (17) | 12,053 | (91.9) | 1062 | (8.1) | 11,125 | (84.8) | 1990 | (15.2) |
Symptomatic (emergency, C1) | ||||||||||
CEA | 6076 | (61) | 5461 | (89.9) | 615 | (10.1) | 4631 | (76.2) | 1445 | (23.8) |
CAS | 3886 | (39) | 3745 | (96.4) | 141 | (3.6) | 3658 | (94.1) | 228 | (5.9) |
Simultaneous procedure (C2) | ||||||||||
CEA | 3802 | (55) | 1734 | (45.6) | 2068 | (54.4) | 1482 | (39.0) | 2320 | (61.0) |
CAS | 3049 | (45) | 2656 | (87.1) | 393 | (12.9) | 2581 | (84.7) | 468 | (15.3) |
Others (C3) | ||||||||||
CEA | 6881 | (69) | 5319 | (77.3) | 1562 | (22.7) | 4445 | (64.6) | 2436 | (35.4) |
CAS | 3109 | (31) | 2710 | (87.2) | 399 | (12.8) | 2591 | (83.3) | 518 | (16.7) |
Overall | Pre-Operative Neurological Assessment | Post-Operative Neurological Assessment | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Yes | No | p | Yes | No | p | |||||||
Any stroke or death | ||||||||||||
Overall | 6254 | (2.74) | 4978 | (3.01) | 1276 | (2.04) | <0.001 | 5331 | (3.74) | 923 | (1.08) | <0.001 |
Asymptomatic (A) | ||||||||||||
CEA | 1461 | (1.45) | 883 | (1.52) | 578 | (1.35) | 0.031 | 1169 | (2.19) | 292 | (0.61) | <0.001 |
CAS | 374 | (1.74) | 278 | (1.82) | 96 | (1.55) | 0.191 | 315 | (2.37) | 59 | (0.72) | <0.001 |
Symptomatic (elective, B) | ||||||||||||
CEA | 1838 | (2.79) | 1660 | (2.84) | 178 | (2.37) | 0.022 | 1608 | (3.53) | 230 | (1.13) | <0.001 |
CAS | 485 | (3.70) | 438 | (3.63) | 47 | (4.43) | 0.220 | 458 | (4.12) | 27 | (1.36) | <0.001 |
Symptomatic (emergency, C1) | ||||||||||||
CEA | 414 | (6.81) | 357 | (6.54) | 57 | (9.27) | 0.014 | 364 | (7.86) | 50 | (3.46) | <0.001 |
CAS | 417 | (10.7) | 401 | (10.7) | 16 | (11.3) | 0.918 | 393 | (10.7) | 24 | (10.5) | 1.000 |
Simultaneous procedure (C2) | ||||||||||||
CEA | 313 | (8.23) | 139 | (8.02) | 174 | (8.41) | 0.700 | 188 | (12.7) | 125 | (5.39) | <0.001 |
CAS | 318 | (10.4) | 287 | (10.8) | 31 | (7.89) | 0.093 | 281 | (10.9) | 37 | (7.91) | 0.063 |
Others (C3) | ||||||||||||
CEA | 386 | (5.61) | 311 | (5.85) | 75 | (4.80) | 0.130 | 328 | (7.38) | 58 | (2.38) | <0.001 |
CAS | 248 | (7.98) | 224 | (8.27) | 24 | (6.02) | 0.147 | 227 | (8.76) | 21 | (4.05) | <0.001 |
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Kallmayer, M.; Knappich, C.; Kirchhoff, F.; Bohmann, B.; Lohe, V.; Naher, S.; Eckstein, H.-H.; Kuehnl, A. Determinants of Pre- and Post-Procedural Neurological Assessment, and Outcome of Carotid Endarterectomy or Stenting. J. Clin. Med. 2024, 13, 4177. https://doi.org/10.3390/jcm13144177
Kallmayer M, Knappich C, Kirchhoff F, Bohmann B, Lohe V, Naher S, Eckstein H-H, Kuehnl A. Determinants of Pre- and Post-Procedural Neurological Assessment, and Outcome of Carotid Endarterectomy or Stenting. Journal of Clinical Medicine. 2024; 13(14):4177. https://doi.org/10.3390/jcm13144177
Chicago/Turabian StyleKallmayer, Michael, Christoph Knappich, Felix Kirchhoff, Bianca Bohmann, Vanessa Lohe, Shamsun Naher, Hans-Henning Eckstein, and Andreas Kuehnl. 2024. "Determinants of Pre- and Post-Procedural Neurological Assessment, and Outcome of Carotid Endarterectomy or Stenting" Journal of Clinical Medicine 13, no. 14: 4177. https://doi.org/10.3390/jcm13144177
APA StyleKallmayer, M., Knappich, C., Kirchhoff, F., Bohmann, B., Lohe, V., Naher, S., Eckstein, H.-H., & Kuehnl, A. (2024). Determinants of Pre- and Post-Procedural Neurological Assessment, and Outcome of Carotid Endarterectomy or Stenting. Journal of Clinical Medicine, 13(14), 4177. https://doi.org/10.3390/jcm13144177