The Journal of cardiovascular surgery最新文献

{"title":"Next-generation transcarotid artery revascularization: TransCarotid flOw Reversal Cerebral Protection And CGUARD MicroNET-Covered Embolic Prevention Stent System To Reduce Strokes - TOPGUARD Study.","authors":"Mariusz Trystula, Isabelle VAN Herzeele, Ralf Kolvenbach, Lukasz Tekieli, Charlotte Fonteyne, Adam Mazurek, Karolina Dzierwa, Jakub Chmiel, Julie Lindsay, Tomasz Kwiatkowski, Adam Hydzik, Maksymilian Oplawski, Krzysztof Bederski, Piotr Musialek","doi":"10.23736/S0021-9509.24.13121-7","DOIUrl":"10.23736/S0021-9509.24.13121-7","url":null,"abstract":"<p><strong>Background: </strong>Stent-assisted carotid artery revascularization employing surgical cutdown for transcervical access and dynamic flow reversal (TCAR) is gaining popularity. TCAR, despite maximized intra-procedural cerebral protection, shows a marked excess of 30-day neurologic complications in symptomatic vs. asymptomatic stenoses. The TCAR conventional single-layer stent (free-cell area 5.89mm²) inability to seal embologenic lesions may be particularly relevant after the flow reversal neuroprotection is terminated.</p><p><strong>Methods: </strong>We evaluated peri-procedural and 30-day major adverse cerebral and cardiac events (MACCE) of TCAR (ENROUTE, SilkRoad Medical) paired with MicroNET-covered neuroprotective stent (CGuard, InspireMD) in consecutive patients at elevated risk of complications with transfemoral/transradial filter-protected stenting (increased lesion-related and/or access-related risk). CGuard (MicroNET free cell area ≈0.02-0.03 mm²) has level-1 evidence for reducing intra- and abolishing post-procedural lesion-related cerebral embolism.</p><p><strong>Results: </strong>One hundred and six increased-risk patients (age 72 [61-76] years, median [Q1-Q3]; 60.4% symptomatic, 49.1% diabetic, 36.8% women, 61.3% left-sided index lesion) were enrolled in three vascular surgery centers. Angiographic stenosis severity was 81 (75-91)%, lesion length 21 (15-26)mm, increased-risk lesional characteristics 87.7%. Study stent use was 100% (no other stent types). 74.5% lesions were predilated; post-dilatation rate was 90.6%. Flow reversal duration was 8 (5-11)min. One stroke (0.9%) occurred in an asymptomatic patient prior to establishing neuroprotection (index lesion disruption with the sheath insertion wire); there were no other peri-procedural MACCE. No further adverse events occurred by 30-days. 30-day stent patency was 100% with normal velocities and absence of any in-stent material by Duplex Doppler.</p><p><strong>Conclusions: </strong>Despite a high proportion of increased-risk lesions and clinically symptomatic patients in this study, TCAR employing the MicroNET-covered anti-embolic stent showed 30-day MACCE rate <1%. This suggests a clinical role for combining maximized intra-procedural prevention of cerebral embolism by dynamic flow reversal with anti-embolic stent prevention of peri- and post-procedural cerebral embolism (TOPGUARD NCT04547387).</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 3","pages":"181-194"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote ischemic conditioning reduces postoperative bleeding in adult cardiac surgical patients: a systematic review and meta-analysis.","authors":"Lin-Lin Chen, Yun-Tai Yao","doi":"10.23736/S0021-9509.24.12827-3","DOIUrl":"10.23736/S0021-9509.24.12827-3","url":null,"abstract":"<p><strong>Introduction: </strong>The current study was designed to systemically investigate the impact of remote ischemic conditioning (RIC) on intra- and postoperative bleeding and transfusion in patients undergoing cardiac surgery.</p><p><strong>Evidence acquisition: </strong>We included all randomized controlled trials (RCTs) comparing RIC with control on intra- and postoperative blood loss and blood transfusion. The inclusion criteria were as follows: 1) adult patients undergoing cardiac surgery; 2) RCT; 3) perioperative administration of RIC compared to control; 4) outcomes of interest reported. Exclusion criteria included: 1) case reports, reviews, or abstracts; 2) animal or cell studies; 3) duplicate publications; 4) studies lacking information about outcomes of interest.</p><p><strong>Evidence synthesis: </strong>Databases search yielded 24 RCTs including 3530 patients, 1765 patients were allocated into RIC group and 1765 into control group. The current study suggested that RIC administration was associated with reduced postoperative blood loss (WMD=-57.89; 95% CI: -89.89 to -25.89; P=0.0004). RIC did not affect the volume of intraoperative blood loss (WMD=-4.02; 95% CI: -14.09 to 6.05; P=0.43), the volume of intra- and postoperative transfusion of red blood cell (RBC) (WMD=-15.66; 95% CI: -39.35 to 8.03; P=0.20), the re-exploration for bleeding (WMD=-0.01; 95% CI: -0.03 to 0.01; P=0.21).</p><p><strong>Conclusions: </strong>The current study demonstrated that, RIC reduced post-operative blood loss in adult patients undergoing cardiac surgeries. It also indicated that, RIC reduced intra-operative RBC transfusion in adult patients undergoing coronary artery bypass grafting. However, RIC did not influence intra-operative bleeding, post-operative blood transfusion.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"280-288"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139975256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between sarcopenia and adverse outcomes after complex endovascular aortic repair.","authors":"Britt W Warmerdam, Carla S van Rijswijk, Anneke Droop, Claudia J Lucassen, Jaap F Hamming, Jan van Schaik, Joost R van der Vorst","doi":"10.23736/S0021-9509.23.12821-7","DOIUrl":"10.23736/S0021-9509.23.12821-7","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is identified as a predictive factor for adverse outcomes after complex endovascular aortic repair (complex EVAR). Consensus on preferred parameters for sarcopenia is not yet reached. The current study compares three CT-assessed parameters on their association with adverse outcomes after complex EVAR.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study. Psoas Muscle Index (PMI), Skeletal Muscle Index (SMI), and lean psoas muscle area (LPMA) were examined by CT-segmentation. PMI, SMI, and LPMA were analyzed as continuous variables. In addition, cut-off values from previous research were used to diagnose patients as sarcopenic or non-sarcopenic. Outcomes were: all-cause mortality, major adverse events (MAE), length of hospital stay, and non-home discharge. A sub-analysis was made for severe sarcopenia; sarcopenia combined with low physical performance (gait speed, Time Up and Go test, Metabolic Equivalent of Task-score).</p><p><strong>Results: </strong>We included 101 patients. A higher PMI (HR=0.590, CI: 0.374-0.930, P=0.023), SMI (HR=0.453, CI: 0.267-0.768, P=0.003), and LPMA (HR=0.559, CI: 0.333-0.944, P=0.029) were associated with a lower risk of mortality. Sarcopenia based on cut-off values for PMI and LPMA was not significantly associated with survival. Sarcopenia based on SMI did present a higher mortality risk (P=0.017). A sub-analysis showed that severely sarcopenic patients were at even higher risk of mortality (P=0.036). None of the parameters were significantly associated with the other outcomes.</p><p><strong>Conclusions: </strong>SMI had a slightly stronger association with mortality compared to PMI and LPMA. High-risk patients were selected by adding physical performance scores. Future research could focus on complex EVAR-specific PMI and LPMA cut-off values.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"256-264"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138178403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In the endless search of the holy grail of \"level 1 evidence\".","authors":"Fabio Verzini","doi":"10.23736/S0021-9509.24.13102-3","DOIUrl":"10.23736/S0021-9509.24.13102-3","url":null,"abstract":"","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 3","pages":"179-180"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midterm outcomes of \"wide neck\" abdominal aortic aneurysm after open or endovascular repair in two European centers: a propensity score matching analysis.","authors":"Daniele Mascia, Annarita Santoro, Giuseppe Panuccio, Sarah Tinaglia, Fiona Rohlffs, Tilo Kölbel, Roberto Chiesa, Germano Melissano","doi":"10.23736/S0021-9509.24.12778-4","DOIUrl":"10.23736/S0021-9509.24.12778-4","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare mid-term clinical and morphological outcomes in patients undergoing open (OR) and endovascular aortic repair (EVAR) with a proximal wide neck abdominal aortic aneurysm (WN-AAA).</p><p><strong>Methods: </strong>Between 2009 and 2014 data of all patients undergoing OR at IRCCS San Raffaele Hospital and EVAR at German Aortic Center Hamburg were retrospectively analyzed. Primary endpoints were aneurysm-related mortality at 5 years, reintervention, and overall mortality. Secondary endpoint was proximal neck enlargement. A 1:1 propensity score matching (PSM) was performed. Survival and freedom from AAA-related reintervention were investigated in matched OR and EVAR group by Kaplan-Meier analysis.</p><p><strong>Results: </strong>Of all OR performed at IRCCS San Raffaele Hospital 70 were found to have a proximal neck >28 mm (mean age: 69.8±7.2 years, 67 [95.71%] male); of all consecutive EVAR performed at German Aortic Center Hamburg, 52 required an endograft size of at least 32 mm (mean age of 73.1±8.7 years, 49 [94.2%] male). After PSM, the study cohort consisted of 30 OR and EVAR. One early mortality was registered in both groups (P=NS). Mid-term freedom from reintervention compared in OR and EVAR, with no statistically significant differences (P=0.979). Eight (15.4%) patients treated with EVAR developed a significant proximal diameter enlargement (≥3 mm) while only 1 (1.4%) patient in the OR group had the same evolution (P<0.01).</p><p><strong>Conclusions: </strong>In WN-AAA neck enlargement is observed more frequently in patients undergoing EVAR, but reintervention rate was similar in the 2 groups, demonstrating that both options were safe and effective.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"265-272"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating complexity with low-crossing profile dual-layer micromesh carotid stent: implications for contemporary carotid artery stenting outcomes (ROADSAVER study insights).","authors":"Ralf Langhoff, Arne Schwindt, Zsolt Vajda, Aleksander Gjoreski, Benjamin Faurie, Sasko Kedev, Stefan Müller-Hülsbeck","doi":"10.23736/S0021-9509.24.13068-6","DOIUrl":"10.23736/S0021-9509.24.13068-6","url":null,"abstract":"<p><strong>Background: </strong>The safety and efficacy of carotid artery stenting (CAS) can be affected by certain technical and anatomical factors. However, it is not known whether the use of a dual-layer micromesh stent (DLMS) with a low-crossing profile could reduce the risks associated with complex vascular anatomies during CAS.</p><p><strong>Methods: </strong>This study involved 1965 asymptomatic or symptomatic carotid artery stenosis patients who received the Roadsaver DLMS during CAS, as part of a prospective, multicenter observational ROADSAVER study, conducted from January 2018 to February 2021. The primary outcome was the 30-day rate of major adverse events (MAE; i.e. any death or stroke) after CAS. Procedural details and outcomes were compared between patients with complex anatomical features and those without.</p><p><strong>Results: </strong>One or more complex anatomical characteristics were identified in 1639 (83.4%) patents. Patients with complex anatomies were older and had a higher prevalence of arterial hypertension, cardiovascular disease, and prior stroke. Between patients with or without complex anatomical features, no significant differences were found either in procedural techniques, or in 30-day MAE (age-adjusted odds ratio (95% CI) for complexities vs. no complexities: 0.76 (0.35, 1.66); p=0.4905) and any stroke (age-adjusted odds ratio (95% CI) for complexities vs. no complexities: 0.89 (0.37, 2.17); p=0.8032) incidence. Furthermore, neither the presence of specific types of anatomic complexity nor their number (per patient) markedly influenced the 30-day MAE and any stroke incidence.</p><p><strong>Conclusions: </strong>In this real-world cohort of patients undergoing CAS with the Roadsaver DLMS, no significant difference in the occurrence of 30-day MAE and any stroke was observed between patients with or without high-risk anatomical features.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 3","pages":"205-212"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ipsilateral dual cannulation is associated with wound complications following veno-arterial ECMO decannulation.","authors":"Aditya Safaya, Sung Yang, Joseph S Giglia, Jose O Moura Leite","doi":"10.23736/S0021-9509.24.12874-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.24.12874-1","url":null,"abstract":"<p><strong>Background: </strong>Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a well-established treatment for severe cardio-pulmonary failure. The use of large bore cannulas in the femoral vessels for an extended period has been associated with significant wound complications. There is a lack of data analyzing risk factors that can mitigate such complications. The primary purpose of this study was to identify modifiable risk factors associated with femoral wound complications after VA ECMO decannulation.</p><p><strong>Methods: </strong>Retrospective analysis of wound complications in patients following VA ECMO decannulation from 2014-2021 at a single academic institution were analyzed. Wound complications were defined as wound infection, dehiscence, or those wounds that were deliberately opened to promote healing by secondary intention.</p><p><strong>Results: </strong>Sixty patients underwent decannulation of VA ECMO with operative repair of the femoral artery. Fifteen patients were identified to have wound complications, eight (53%) of these had infection. Fourteen (93%) patients had wound dehiscence or had their wound purposely opened at bedside. Univariate analysis revealed no association of access-related complication with higher Body Mass Index (BMI, 28.3 vs. 32.7 kg/m², P=0.110) but here was a trend in having more wound complications in individuals with COVID-19 infection (6.7% vs. 26.7%, P=0.058). Patients that had dual cannulation with the arterial and venous cannulas in the same groin had significantly more wound complications compared to single cannulation arterial and venous cannulas in separate groins (57.8% vs. 93.3%; P=0.012). Multivariate analysis revealed same side cannulation (OR 18.05, 95% CI 1.44-226.18, P=0.025) and COVID-19 infection (OR 18.18, 95% CI 1.50-220.66, P=0.023) were independent predictors of wound complications.</p><p><strong>Conclusions: </strong>Wound complications after VA ECMO decannulation is associated with COVID-19 infection and having venous and arterial cannulas in the same groin. We recommend that the arterial and venous cannulation be placed in different groins in patients that require VA ECMO.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 3","pages":"296-301"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-resectional cordal repair for Barlow mitral valve disease.","authors":"Isabella S Florissi, Matthew Acton, Irina Kolesnik, Chetan Pasrija, Ishani Patel, Eric Etchill, Sari D Holmes, Rachael Quinn, James S Gammie","doi":"10.23736/S0021-9509.24.12899-6","DOIUrl":"10.23736/S0021-9509.24.12899-6","url":null,"abstract":"<p><strong>Background: </strong>The redundant leaflet tissue and annular pathology of Barlow disease can make surgical repair challenging. We examined perioperative and late outcomes of a large cohort of patients with Barlow disease undergoing surgical repair.</p><p><strong>Methods: </strong>Patients included in this analysis underwent mitral valve repair from 01/2004-11/2021 by a single surgeon.</p><p><strong>Results: </strong>Of 2798 patients undergoing mitral valve operations, 46% (N.=1292) had degenerative pathology and 7% (N.=184) had Barlow disease. Of the 179 Barlow patients, median age at surgery was 62 (51-70) years; 64% were male (115/179). Rates of non-resectional cordal repair and resectional repair were 86% (154/179) and 14% (25/179). Among patients undergoing non-resectional repair, the median number of cordal pairs inserted on the anterior and posterior leaflets was 2 (2-3) and 4 (3-4). Incidence of return to bypass for systolic anterior motion of the mitral valve, perioperative death, stroke, and renal failure was 2% (4/179), 1% (2/179), 0% (0/179), and 0% (0/179). Rates of clinical and echocardiographic follow-up were 93% (165/177) and 89% (157/177). Median time to latest postoperative clinical and echocardiographic follow-up was 2.4 (0.8-6.1) and 2.1 (0.6-4.7) years. Mitral regurgitation grade at latest follow-up or time of repair failure was none/trace, mild, mild to moderate, and severe in 63% (98/157), 26% (41/157), 8% (12/157), and 4% (6/157); five of six patients with severe MR underwent reoperation. Since 2011 97% (139/144) of patients underwent cordal repair without resection.</p><p><strong>Conclusions: </strong>Non-resectional artificial cordal repair is safe and feasible in almost all patients with Barlow valves and is associated with excellent mid-term results.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"289-295"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase-specific survival after endovascular versus open surgical repair of descending thoracic aortic aneurysm.","authors":"Nidhi Iyanna, Takuya Ogami, Yujiro Yokoyama, Hisato Takagi, Derek Serna-Gallegos, Danny Chu, Ibrahim Sultan, Toshiki Kuno","doi":"10.23736/S0021-9509.24.12855-8","DOIUrl":"10.23736/S0021-9509.24.12855-8","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracic endovascular aortic repair (TEVAR) has gained preference over open surgical repair (OSR) as the intervention of choice for patients with descending thoracic aortic aneurysm (DTA). This study aimed to compare the outcomes of patients with DTA undergoing OSR and TEVAR with contemporary findings.</p><p><strong>Evidence acquisition: </strong>A comprehensive search of MEDLINE and EMBASE databases was conducted to identify relevant randomized controlled trials or studies utilizing propensity-score analysis or reporting risk-adjusted outcomes. The search was performed up until March 2023.</p><p><strong>Evidence synthesis: </strong>Eight studies met the inclusion criteria, including 4 studies using propensity-score matching and four studies reporting risk-adjusted outcomes, comprising 14,873 patients with DTA undergoing OSR (N.=10,882) and TEVAR (N.=3991). Operative mortality was similar between the two interventions (odds ratio 0.92, 95% CI 0.70-1.21, P=0.57, I²=0%). However, overall long-term mortality was significantly higher after TEVAR compared to OSR (Hazard Ratio [HR] 1.30, 95% CI 1.05-1.59, P=0.01, I²=0%). Phase-specific analysis revealed comparable risks of mortality within 1 year and between one and two years after interventions, while the risk of mortality was significantly higher after TEVAR compared to OSR beyond two years (HR 1.77, 95% CI, 1.19-2.63, P=0.01. I²=0%).</p><p><strong>Conclusions: </strong>This study demonstrated comparable operative mortality between OSR and TEVAR, but higher long-term mortality associated with TEVAR in patients with DTA. The phase-specific analysis highlighted the survival advantage of OSR beyond 2 years. These findings suggest a need for reconsidering OSR indications in the management of DTA.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":"249-255"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in acute carotid-related stroke eligible for mechanical reperfusion: SAFEGUARD-STROKE Registry.","authors":"Lukasz Tekieli, Karolina Dzierwa, Iris Q Grunwald, Adam Mazurek, Malgorzata Urbanczyk-Zawadzka, Lukasz Wiewiorka, R Pawel Banys, Wladyslaw Dabrowski, Anna Podlasek, Ewa Weglarz, Justyna Stefaniak, Rafal T Nizankowski, Piotr Musialek","doi":"10.23736/S0021-9509.24.13093-5","DOIUrl":"10.23736/S0021-9509.24.13093-5","url":null,"abstract":"<p><strong>Background: </strong>Carotid-related strokes (CRS) are largely unresponsive to intravenous thrombolysis and are often large and disabling. Little is known about contemporary CRS referral pathways and proportion of eligible patients who receive emergency mechanical reperfusion (EMR).</p><p><strong>Methods: </strong>Referral pathways, serial imaging, treatment data, and neurologic outcomes were evaluated in consecutive CRS patients presenting over 18 months in catchment area of a major carotid disease referral center with proximal-protected CAS expertise, on-site neurology, and stroke thrombectomy capability (Acute Stroke of CArotid Artery Bifurcation Origin Treated With Use oF the MicronEt-covered CGUARD Stent - SAFEGUARD-STROKE Registry; companion to SAFEGUARD-STROKE Study NCT05195658).</p><p><strong>Results: </strong>Of 101 EMR-eligible patients (31% i.v.-thrombolyzed, 39.5% women, age 39-89 years, 94.1% ASPECTS 9-10, 90.1% pre-stroke mRS 0-1), 57 (56.4%) were EMR-referred. Referrals were either endovascular (Comprehensive Stroke Centre, CSC, 21.0%; Stroke Thrombectomy-Capable CAS Centre, STCC, 70.2%) or to vascular surgery (VS, 1.8%), with >1 referral attempt in 7.0% patients (CSC/VS or VS/CSC or CSC/VS/STCC). Baseline clinical and imaging characteristics were not different between EMR-treated and EMR-untreated patients. EMR was delivered to 42.6% eligible patients (emergency carotid surgery 0%; STCC rejections 0%). On multivariable analysis, non-tandem CRS was a predictor of not getting referred for EMR (OR 0.36; 95%CI 0.14-0.93, P=0.03). Ninety-day neurologic status was profoundly better in EMR-treated patients; mRS 0-2 (83.7% vs. 34.5%); mRS 3-5 (11.6% vs. 53.4%), mRS 6 (4.6% vs. 12.1%); P<0.001 for all.</p><p><strong>Conclusions: </strong>EMR-treatment substantially improves CRS neurologic outcomes but only a minority of EMR-eligible patients receive EMR. To increase the likelihood of brain-saving treatment, EMR-eligible stroke referral and management pathways, including those for CSC/VS-rejected patients, should involve stroke thrombectomy-capable centres with endovascular carotid treatment expertise.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":"65 3","pages":"231-248"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141617984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}