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Outcomes of carotid stenting in patients with fibromuscular dysplasia.
Porras-Colon, Jesus; Scott, Carla K; Pizano, Alejandro; Driessen, Anna; Timaran, Carlos H; Modrall, John G; Tsai, Shirling; Kirkwood, Melissa L; Ramanan, Bala.
Afiliación
  • Porras-Colon J; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
  • Scott CK; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
  • Pizano A; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
  • Driessen A; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
  • Timaran CH; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
  • Modrall JG; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Division of Vascular and Endovascular Surgery, Department of Surgery, Dallas Veterans Affairs Medical Center, Dallas, TX.
  • Tsai S; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Division of Vascular and Endovascular Surgery, Department of Surgery, Dallas Veterans Affairs Medical Center, Dallas, TX.
  • Kirkwood ML; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
  • Ramanan B; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Division of Vascular and Endovascular Surgery, Department of Surgery, Dallas Veterans Affairs Medical Center, Dallas, TX. Electronic address: bala.ramanan@utsouthwestern
J Vasc Surg ; 77(3): 829-835, 2023 03.
Article en En | MEDLINE | ID: mdl-36400362
OBJECTIVE: Fibromuscular dysplasia (FMD) is a noninflammatory arterial disease that affects the extracranial carotid arteries in young patients. The ideal treatment of FMD has continued to be debated, and the role of carotid artery stenting (CAS) is controversial. The aim of the present study was to assess the feasibility and outcomes of CAS for patients with FMD. METHODS: A retrospective analysis of patients who had undergone CAS was performed using the Vascular Quality Initiative database from December 2012 to May 2021. Patients who had undergone CAS for atherosclerosis and FMD were included and matched 1:1 by age, gender, and clinical presentation. The demographics, clinical parameters, and procedural data were analyzed. The end points included postoperative stroke and transient ischemic attack (TIA), and adverse events (perioperative and 1-year mortality, neurologic changes, access site complications, hematoma or bleeding, infection, congestive heart failure, arrhythmia, myocardial infarction, reperfusion symptoms), and hospital length of stay. RESULTS: After matching, 55 patients had undergone CAS for FMD (mean age, 58.7 ± 14 years; 62% women; 69% White; mean body mass index, 28 ± 6 kg/m2). Most of these procedures (69%) were elective. The FMD group had had a lower rate of hypertension (55% vs 82%; P = .002), smoking (35% vs 80%; P < .001), diabetes (13% vs 45%; P < .001), and coronary artery disease (9% vs 45%; P < .001) compared with the non-FMD group. In the FMD group, prior TIA and stroke was identified in 39 (71%) and 31 (57%) patients, respectively. The mean interval from a prior stroke or TIA to the index surgery was 160 days. Additionally, 23 patients (42%) had had anatomically high lesions above the level of the second cervical vertebra. In the FMD group, the transfemoral approach was used for 43 patients (78%), with distal embolic protection used for 40 patients (93%). Flow reversal was used for nine patients (23%). Most cases were performed with local anesthesia (58%). Three patients (6%) in the FMD group had had access site complications that were managed nonoperatively. No differences were found between the FMD and non-FMD groups in perioperative stroke, TIA, or 30-day mortality. The length of stay was similar between the two groups, and the 1-year survival was 100% for both groups. All the patients in the FMD group were discharged without neurologic complications, and 50 patients (91%) were receiving dual antiplatelet therapy. The median follow-up was 328 days (interquartile range, 1-732 days) with no mortality or reinterventions during follow-up. CONCLUSIONS: CAS for FMD is a feasible and safe procedure with favorable technical success, a low incidence of neurologic complications, and good clinical outcomes at 1 year of follow-up.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ataque Isquémico Transitorio / Estenosis Carotídea / Accidente Cerebrovascular / Displasia Fibromuscular Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ataque Isquémico Transitorio / Estenosis Carotídea / Accidente Cerebrovascular / Displasia Fibromuscular Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Vasc Surg Asunto de la revista: ANGIOLOGIA Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos