Perioperative Outcomes Following Carotid Revascularization for Stroke Stratified by Modified Rankin Scale and Time of Intervention

The relationship between modified Rankin Scale (mRS) and optimal timing of carotid revascularization in patients with prior stroke is unclear. Therefore, we compared outcomes transfemoral artery stenting (TFCAS), transcarotid (TCAR), endarterectomy (CEA) after stroke, stratified by accounting for preoperative mRS time-to-intervention. We identified all who underwent TFCAS, TCAR, CEA a recent the Vascular Quality Initiative 2012 to 2020. Patients were into four groups (mRS 0-1, 2, 3-4, 5) based on days from symptom onset (≤2 days, 3-14 15-90 91-180 days). Primary outcome was in-hospital stroke/death rate TFCAS vs TCAR CEA, within different time-to-intervention groups. 4415 3138 20,062 CEA. most likely have minimal disability 0-1; 61%) least severe 5; 1.5%). often 3 14 (45%) 91 180 (8.6%). Across intervention methods, increasing associated higher (all P < .02), while lower .01). After risk adjustment, undergoing (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.5-2.1; .01) or (aOR, 1.5; CI, 1.2-1.9; (Table). observed similar rates when 1.2; 1.0-1.5; = .08). Optimal varies severity. While did not observe distinct associations increased TCAR. Our results indicate effect time perioperative revascularization, these variables should be adjusted controlled future studies. demonstrating delayed need weighed against natural history recurrent events.TableUnadjusted death (stroke/death) procedures association procedure interventionmRS 0-1mRS 2mRS 3-4mRS 5S/D ratesOR95% CIP valueS/D value≤2 TFCAS7.5%2.51.5-4.1<.017.0%1.50.7-3.5.3111%1.40.9-2.3.1523%3.00.8-11.10 TCAR3.7%0.90.3-2.7.857.0%1.90.5-7.5.3714%1.60.5-5.2.41NA- CEA3.4%Ref4.7%Ref8.5%Ref8.3%Ref3-14 TFCAS2.7%1.30.8-2.2.274.2%1.10.6-2.2.695.3%1.50.9-2.5.1226%2.30.5-9.4.26 TCAR2.9%1.30.8-2.1.305.7%1.30.7-2.5.343.9%1.00.5-1.9.990.0%- CEA1.9%Ref3.9%Ref3.8%Ref12%Ref15-90 TFCAS2.5%2.01.1-3.5.025.0%1.90.8-4.7.174.5%1.40.6-3.4.409.1%0.50.0-14.71 TCAR2.2%1.60.9-2.7.122.9%1.00.3-2.91.05.2%1.60.7-3.6.250.0%- CEA1.3%Ref2.2%Ref3.0%Ref10%Ref91-180 TFCAS1.1%0.70.2-3.0.613.8%1.10.2-6.8.916.7%5.41.0-28.0433%- TCAR2.4%1.00.4-2.61.00.0%-1.6%1.00.1-11.990.0%- CEA1.9%Ref4.1%Ref1.2%Ref0.0%-All Cohorts CEA2.6%Ref TFCAS6.3%1.81.5-2.1<.01 TCAR3.2%1.21.0-1.5.08 TCAR3.2%Ref TFCAS6.3%1.51.2-1.9<.01CI, Confidence interval; OR, ratio; S/D, death.Adjusted age, race, sex, current smoking status, chronic obstructive pulmonary disease, hypertension, coronary congestive heart failure, estimated glomerular filtration <30 mL/min, mRS, intervention. Open table new tab