Key points are not available for this paper at this time.
Within the cardiology literature, coronary calcium scores have been established as an easily automated way to use cross-sectional imaging to predict cardiovascular events and death. No analog exists within the vascular surgical literature. Using cross-sectional imaging on patients undergoing transcarotid arterial revascularization (TCAR), we used a previously published standardized, semiautomated technique to obtain atherosclerotic plaque calcium quantification. We examined the impact of carotid calcium volume percent on postoperative stroke/death, hypothesizing that increased calcium burden would be associated with increased stroke/death. Patients who underwent TCAR from 2015 to 2023 were stratified into high- or low-calcium volume percent using the median value. Stroke and mortality dates were obtained from patient records. The primary outcome was composite stroke/death. Patient factors and outcomes were compared using Student's t test, Pearson's χ2 test, Fisher's exact test, and the Mann-Whitney test. Kaplan-Meier analysis was performed for 3-year freedom from stroke/death and Cox proportional hazards modeling for factors associated with stroke/death. A total of 242 patients underwent TCAR from December 2015 to January 2023 at our institution. The high-calcium group had more female patients (38.0% vs 24.0%, P = .03), was older (74.6 ± 7.9 years vs 70.5 ± 9.4 years, P < .01), and had a higher rate of hypertension (95.0% vs 86.0%, P = .03). Rates of symptomatic disease were similar between the groups (41.7% high calcium vs 51.2% low calcium, P = .17). The mean calcium volume was 2.9% ± 2.8% for low calcium vs 20.7% ± 9.7% in the high calcium group (P < .01). Thirty-day stroke/death occurred only in the high-calcium group and was equivalent when stratified by symptomatic status (1.7% asymptomatic vs 3.3% symptomatic, P = .23). At 3 years, the low-calcium group demonstrated greater freedom from stroke/death (P = .03) (Fig). Mortality rate was higher in the high-calcium group (20.7% vs 9.1%, P = .02) though with fewer strokes (0.0% vs 2.5%, P = .25). Cox proportional hazards analysis showed that factors associated with stroke/death were congestive heart failure (hazard ratio HR: 4.5, 95% confidence interval CI: 2.3-9.0; P < .01) and chronic kidney disease (HR: 2.2, 95% CI: 1.1-4.3; P = .03). Low-calcium volume percent (HR: 0.5, 95% CI: 0.3-1.0; P = .05) was protective. Using a novel volumetric technique for quantification of carotid plaque calcium burden, we demonstrated that lower calcium volume percent is associated with a lower combined stroke/death rate at 3 years. This may reflect that a higher carotid calcium burden is associated with greater systemic calcification and thus higher cardiovascular risk. In addition, a patient's comorbid profile is strongly associated with stroke/death in the midterm. These data provide additional anatomic-based data to aid in risk-benefit analysis in patients undergoing minimal access carotid surgery.
Grafmuller et al. (Mon,) studied this question.