Asymptomatic Patients With a Remote History of Transient Ischemic Attack or Stroke May Benefit From Reduced Hazard of In-hospital Death After Transcarotid Artery Revascularization
Jerry Zhu, Ajit Rao, Anthony Turner, Windsor Ting, Daniel Han, Rami Tadros, David Finlay, Ageliki Vouyouka, Michael Marin, Peter Faries
The Mount Sinai Hospital, New York, NY
BACKGROUND: Asymptomatic patients with remote history of transient ischemic attack (TIA) or stroke are not well studied as a separate population from asymptomatic patients with no prior history of TIA or stroke. We compared in-hospital outcomes following transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (TFCAS) among symptomatic and asymptomatic patients with and without a history of TIA or stroke. METHODS: Data from patients in the Vascular Quality Initiative database undergoing TCAR (Jan 2017 to Apr 2020) or TFCAS (May 2005 to Apr 2020) was analyzed. Symptomatic status was defined as TIA and/or stroke within 180 days prior to procedure. Asymptomatic status was divided into patients with no history of TIA/stroke (asymptomatic A) and TIA and/or stroke occurring more than 180 days prior to procedure (asymptomatic B). Student t-test and chi-square test were used to compare baseline patient characteristics and outcomes. Multivariate logistic regression was used to adjust for significant between-group differences in baseline characteristics. RESULTS: There were 7,158 patients who underwent TCAR (symptomatic:2,574; asymptomatic A:3,689; asymptomatic B:895) and 18,023 patients who underwent TFCAS (symptomatic:6,195; asymptomatic A:10,333; asymptomatic B:1,495). TCAR patients were generally older, white, smokers, and had more comorbidities than TFCAS. Asymptomatic B patients had higher rates of TIA, stroke, TIA/stroke, stroke/death, and stroke/death/MI than asymptomatic A patients, and these rates were similar to those of symptomatic patients (Table 1). Comparing TCAR and TFCAS among asymptomatic B patients, there were statistically significant reductions in the odds of stroke/death (OR:0.46, 95%CI:0.27-0.84, P=0.011) and stroke/death/MI (OR:0.51, 95%CI:0.30-0.87, P=0.013) after TCAR. A greater reduction in the odds of death was observed among asymptomatic B patients (OR:0.30, 95%CI:0.084-1.110, P=0.069) compared to asymptomatic A patients (OR:0.41, 95%CI:0.20-0.85, P=0.017), which was likely driven by the increased rate of death for TFCAS asymptomatic B patients (0.9%) compared to asymptomatic A (0.6%)
CONCLUSIONS: Asymptomatic patients with a remote history of TIA/stroke do not have the same outcomes as asymptomatic patients without a history of TIA/stroke and are at higher risk of adverse in-hospital events. Asymptomatic patients with a remote history of TIA/stroke have increased risk of in-hospital death after TFCAS and may benefit from TCAR.
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