Management of Carotid Artery Disease
Sprache: D/E
Slides: E
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Impact of Cerebrovaskular Disease on the European Health Care System
- Presentation time:
- 3 min
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Keynote: The Importance of Interdisciplinary Teams in Clinical Decision-Making
- Presentation time:
- 12 min
- Discussion time:
- 3 min
Speaker: David Rimmele (Luzern)
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The Neurologist’s Perspective on Vascular Disease: From Optimal Medical Treatment to Interventions—Insights from CREST-2
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Marcel Arnold (Bern)
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Vulnerable Plaque in Cerebrovascular Disease: Definition, Diagnosis, and Clinical Implications
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Alexander von Hessling (Luzern)
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Management of ACI Stenosis Following Interventional Thrombectomy: Current Evidence
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Martin Storck (Karlsruhe)
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Rare Conditions of the Carotid Artery: Carotid Web, Free-Floating Thrombus, and More—What Are the Options?
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Barbara Rantner (München)
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Treatment of Symptomatic Tandem Lesions
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Jan Gralla (Bern)
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Hyperperfusion Syndrome After Revascularization: Prevention, Diagnosis, and Management
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Speaker: Regula von Allmen (St. Gallen)
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Effect of preoperative dual antiplatelet therapy on outcome after carotid endarterectomy. A nationwide propensity score matched cohort study.
- Presentation time:
- 7 min
- Discussion time:
- 3 min
Presenting Author: Justine Longchamp (Lausanne)
Objective
So far, risk balance between peri-operative stroke and bleeding was mainly accessed with asymptomatic CEA cohort showing that DAPT reduces peri-operative stroke but increased major bleeding complications
The primary outcome of this present study is to analyse if DAPT for symptomatic carotid artery stenosis is associated with reduced risk of ipsilateral stroke after CEA. Secondary outcomes are other postoperative outcomes e.g. risk of reoperation for neck haematoma, intracerebral bleeding and any stroke or death
Methods
Retrospective analysis of all CEA for symptomatic carotid stenosis registered in a nationwide registry with high external and internal validity, between 2021 and 2024.
Two groups were identified according to antiplatelet regimen and were matched in confounders. The Fisher exact test was used for categorical data whenever and a t test was used for continuous data; PSM was performed in a non-parsimonious fashion with a 1:1 ratio and a calliper of 0.1.Results
In total, 2686 patients met inclusions criteria and were included in our analysis. After PSM, 510 patients were included in each group (Figure 1). After PSM, Median age was 75 years (69-79), p=0.23, in both groups. There were 38% of woman in the SAPT group and 35% in the DAPT group, p=0.27. There was no difference regarding comorbidities between both groups (Table 1). Heparin was administered in 93% in the SAPT group versus 92% in the DAPT group, p=0.11. Protamine was significantly more administered in the DAPT group (35%) versus in the SAPT group (12%), p<0.001.
Regarding early complications, after propensity score matching, there were no difference in ipsilateral stroke at 30 days: 1% in each group, p=1. Reoperation for neck hematoma was significant higher in the DAPT group 3% versus 1% in the SAPT group, p=<0.001 (Table 2).
For the whole cohort, multivariate regression analysis showed that DAPT was the only significant risk factor associated with reoperation for neck hematoma (OR 3.06, p=0.007). Use of protamine did not affect the risk of reoperation from bleeding OR 1.35, p=0.33.
Kaplan-Meier curve showed no significant survival difference between both groups (p=0.46) (Figure 2).Conclusion
Preoperative DAPT is associated with increased risk of reoperation for bleeding after carotid endarterectomy but does not affect the risk of postoperative stroke.