Key result
Carotid artery stenting with intensive medical therapy in high-risk patients resulted in a 1-year composite rate of stroke, cardiovascular death, or myocardial infarction of 10.9%, with age ≥80 years significantly increasing this risk (OR 4.41).
Why the study?
Does carotid artery stenting with intensive medical therapy prevent stroke and cardiovascular events in high-risk patients with carotid artery stenosis?
Cohort (n=184)
No
Does carotid artery stenting with intensive medical therapy prevent stroke and cardiovascular events in high-risk patients with carotid artery stenosis?
Carotid artery stenting in high-risk patients on intensive medical therapy showed acceptable outcomes in symptomatic patients, but complication rates in asymptomatic patients exceeded guideline-recommended thresholds.
May warrant caution with stenting in octogenarians; leaves open net benefit versus intensive medical therapy alone in high-risk stenosis.
Kontext: Implantace stentĹŻ do karotickĂ˝ch tepen (carotid artery stenting, CAS) se v souÄasnosti ve velkĂŠm mÄĹĂtku pouĹžĂvĂĄ v lĂŠÄbÄ stenĂłzy karotickĂ˝ch tepen. KlinickĂŠ studie z poslednĂ doby prokĂĄzaly nĂzkou incidenci pĹĂhod po CAS. Tato studie hodnotĂ 30dennĂ a roÄnĂ vĂ˝sledky pacientĹŻ lĂŠÄenĂ˝ch pro CAS intenzivnĂ farmakoterapiĂ na pracoviĹĄti provĂĄdÄjĂcĂm vysokĂŠ poÄty perkutĂĄnnĂch koronĂĄrnĂch intervencĂ roÄnÄ.Metoda: V obdobĂ od ledna 2011 do prosince 2013 byla CAS provedena celkem u 184 pacientĹŻ. Mimo protidestiÄkovĂŠ lĂŠÄby byla provĂĄdÄna i intenzivnĂ antihypertenznĂ lĂŠÄba spolu s vysoce intenzivnĂ terapiĂ statiny a lĂŠÄbou zamÄĹenou na normalizaci srdeÄnĂ frekvence. Pacienti byli stratifikovĂĄni podle vÄku a symptomĹŻ.VĂ˝sledky: VÄtĹĄina pacientĹŻ (86,4 %) splĹovala alespoĹ jedno kritĂŠrium vysokĂŠho operaÄnĂho rizika. VĂ˝kon byl ĂşspÄĹĄnĂ˝ v 98,4 % pĹĂpadĹŻ. TĹicetidennĂ a roÄnĂ incidence cĂŠvnĂch mozkovĂ˝ch pĹĂhod (CMP) byla 4,1 %, resp. 4,5 %. Po 30 dnech byla kombinovanĂĄ incidence CMP/ĂşmrtĂ z kardiovaskulĂĄrnĂch (KV) pĹĂÄin/infarktu myokardu (IM) 5,8 %; po jednom roce dosĂĄhla hodnoty 10,9 %. TĹicetidennĂ incidence CMP/ĂşmrtĂ z KV pĹĂÄin u asymptomatickĂ˝ch a symptomatickĂ˝ch pacientĹŻ byla 5,4 %, resp. 4,2 %. VÄk ≥ 80 let zvyĹĄoval riziko vzniku CMP/ĂşmrtĂ z KV pĹĂÄin/IM do jednoho roku (OR 4,41; 95% CI 1,06-18,36; p = 0,04).ZĂĄvÄry: Studie prokĂĄzala pĹijatelnĂŠ klinickĂŠ vĂ˝sledky pacientĹŻ s CAS a vysokou incidencĂ pĹidruĹženĂ˝ch onemocnÄnĂ, kteĹĂ byli lĂŠÄeni intenzivnĂ farmakoterapiĂ. Incidence pĹĂhod u symptomatickĂ˝ch pacientĹŻ nepĹesĂĄhla rozmezĂ uvĂĄdÄnĂŠ v guidelines jako doporuÄenĂŠ, zatĂmco u asymptomatickĂ˝ch pacientĹŻ byla incidence zvýťenĂĄ.
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Trušinskis et al. (2015) conducted a cohort in Carotid artery stenosis (n=184). Carotid artery stenting with intensive medical therapy was evaluated on Composite of stroke, cardiovascular death, or myocardial infarction at 1 year. Carotid artery stenting with intensive medical therapy in high-risk patients resulted in a 1-year composite rate of stroke, cardiovascular death, or myocardial infarction of 10.9%, with age ≥80 years significantly increasing this risk (OR 4.41).
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