Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI)
Background Multiple studies have highlighted the importance of carotid artery stenting (CAS) operator's experiences. However, fellowship‐trained neurointerventionalists remain an under‐represented specialty in the literature. We aim to report the complication rate of CAS performed exclusively b...
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2025-01-01
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| Series: | Stroke: Vascular and Interventional Neurology |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.124.001459 |
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| author | Mohamad Ezzeldin Ameer E. Hassan Ali Kerro Maria Martucci Muhammad Shazam Hussain Osman Mir Faheem G. Sheriff Peter Kan Chizoba Ezepue Nazli A. Janjua Kaiz S. Asif Ramesh Grandhi Ali Alaraj Muhammad Niazi Ossama Yassin Mansour Michael Chen Saif Bushnaq Omar Tanweer Adnan H. Siddiqui Adam Delora Rime Ezzeldin Bains Navpreet Varun Chaubal Mohammad Ammar Abdulrazzak Hamzah Saei Gustavo J. Rodriguez Mohammad AlMajali Gautam Edhayan Amer Al Shekhlee Christopher Hadjialiakbari Musaab Froukh Walid K. Salah Elsa Nico Adrusht Madapoosi Yazan Radiaideh Darko Quispe‐Orozco Oz Haim Noel Garza Alberto Maud Morgan Rolon‐Newton Benan Barakat Tejas Gowda Muhammad Monk Zuhair Ali Tunmi Anwoju Osama O. Zaidat Farhan Siddiq |
| author_facet | Mohamad Ezzeldin Ameer E. Hassan Ali Kerro Maria Martucci Muhammad Shazam Hussain Osman Mir Faheem G. Sheriff Peter Kan Chizoba Ezepue Nazli A. Janjua Kaiz S. Asif Ramesh Grandhi Ali Alaraj Muhammad Niazi Ossama Yassin Mansour Michael Chen Saif Bushnaq Omar Tanweer Adnan H. Siddiqui Adam Delora Rime Ezzeldin Bains Navpreet Varun Chaubal Mohammad Ammar Abdulrazzak Hamzah Saei Gustavo J. Rodriguez Mohammad AlMajali Gautam Edhayan Amer Al Shekhlee Christopher Hadjialiakbari Musaab Froukh Walid K. Salah Elsa Nico Adrusht Madapoosi Yazan Radiaideh Darko Quispe‐Orozco Oz Haim Noel Garza Alberto Maud Morgan Rolon‐Newton Benan Barakat Tejas Gowda Muhammad Monk Zuhair Ali Tunmi Anwoju Osama O. Zaidat Farhan Siddiq |
| author_sort | Mohamad Ezzeldin |
| collection | DOAJ |
| description | Background Multiple studies have highlighted the importance of carotid artery stenting (CAS) operator's experiences. However, fellowship‐trained neurointerventionalists remain an under‐represented specialty in the literature. We aim to report the complication rate of CAS performed exclusively by neurointerventionalists. Methods Retrospective cohort study regarding stenting symptomatic and asymptomatic carotid stenosis was collected at multiple comprehensive stroke centers. The primary outcome included a composite of the 30‐day periprocedural mortality, symptomatic ischemic stroke, symptomatic intracranial hemorrhage, and myocardial infarction. The secondary outcomes included other complications. Chi‐squared tests were performed for categorical variables, and Welch's t‐test was used for continuous variables. Cutoffs in continuous variables were estimated using grid search optimization. Sensitivity analyses were performed for missing data. Results Between 2018 and 2022, 1445 CAS procedures were performed by 38 neurointerventionalists. We have 30‐day outcome data on 1281 patients. Patients were predominantly symptomatic (93.01%), male (65.79%), White (70.36%), and had a median age of 69. The primary outcomes occurred in 26 (1.8%) cases, with 13 (0.9%) death, 8 (0.55%) symptomatic ischemic stroke, 4 (0.28%) symptomatic intracranial hemorrhage, and 1 (0.07%) myocardial infarction. A statistically significant increase in all outcomes correlated with advanced age (P = 0.001), women (P = 0.013), aortic arch type 3 (P = 0.01), and higher preprocedural modified Rankin score (P = 0.006). Secondary outcomes were higher in Hispanic and Black patients (P = 0.007) and those with low diastolic blood pressure at stenting (P = 0.04). Conclusion CAS, conducted by fellowship‐trained neurointerventionalist physicians in comprehensive stroke centers, demonstrates a lower complication rate than what was previously reported in CAS, carotid endarterectomy, and transcarotid artery revascularization literature. Physician training, higher frequency, and standardized stroke care in a comprehensive stroke center may contribute to this low complication rate. |
| format | Article |
| id | doaj-art-6ed208a89bcd4ec5a8382690679b5b2a |
| institution | Kabale University |
| issn | 2694-5746 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj-art-6ed208a89bcd4ec5a8382690679b5b2a2025-01-11T08:01:41ZengWileyStroke: Vascular and Interventional Neurology2694-57462025-01-015110.1161/SVIN.124.001459Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI)Mohamad Ezzeldin0Ameer E. Hassan1Ali Kerro2Maria Martucci3Muhammad Shazam Hussain4Osman Mir5Faheem G. Sheriff6Peter Kan7Chizoba Ezepue8Nazli A. Janjua9Kaiz S. Asif10Ramesh Grandhi11Ali Alaraj12Muhammad Niazi13Ossama Yassin Mansour14Michael Chen15Saif Bushnaq16Omar Tanweer17Adnan H. Siddiqui18Adam Delora19Rime Ezzeldin20Bains Navpreet21Varun Chaubal22Mohammad Ammar Abdulrazzak23Hamzah Saei24Gustavo J. Rodriguez25Mohammad AlMajali26Gautam Edhayan27Amer Al Shekhlee28Christopher Hadjialiakbari29Musaab Froukh30Walid K. Salah31Elsa Nico32Adrusht Madapoosi33Yazan Radiaideh34Darko Quispe‐Orozco35Oz Haim36Noel Garza37Alberto Maud38Morgan Rolon‐Newton39Benan Barakat40Tejas Gowda41Muhammad Monk42Zuhair Ali43Tunmi Anwoju44Osama O. Zaidat45Farhan Siddiq46Department of Neuroendovascular Surgery HCA Houston Healthcare Kingwood Kingwood TXDepartment of Neurology Valley Baptist Medical Center Brownsville TXDepartment of Neurology HCA Houston Healthcare Conroe Conroe TXDepartment of Neurology Cleveland Clinic Cleveland OHDepartment of Neurology Cleveland Clinic Cleveland OHDepartment of Neurology Texas Stroke Institute Plano TXDepartment of Neurology Texas Tech University Health Sciences Center El Paso TXDepartment of Neurosurgery University of Texas Medical Branch (UTMB) Galveston TXDepartment of Neurology SSM Health Saint Louis University Hospital St. Louis MODepartment of Neurology, Asia Pacific Comprehensive Stroke Network Pomona Valley Hospital Medical Center Pomona CADepartment of Neurology Ascension Health and University of Illinois Chicago (UIC) Chicago ILDepartment of Neurosurgery University of Utah Salt Lake City UTDepartment of Neurosurgery University of Illinois Chicago (UIC) Chicago ILDepartment of Neurology WellSpan Health York PADepartment of Neurology Alexandria University Alexandria EgyptDepartment of Neurology Rush University Medical Center Chicago ILDepartment of Neurology Texas Tech University Lubbock TXDepartment of Neurosurgery Baylor St. Lukes Medical Center Houston TXDepartment of Neurosurgery State University of New York at Buffalo's Jacobs School of Medicine and Biomedical Sciences New York NYDepartment of Emergency Medicine HCA Houston Healthcare Kingwood Kingwood TXMedicine Jordan University of Science and Technology Irbid JordanDepartment of Neurosurgery University Hospital Missouri Columbia MODepartment of Neurology St. Vincent Medical Center Toledo OHDepartment of Neurology Cleveland Clinic Cleveland OHDepartment of Neurology Valley Baptist Medical Center Brownsville TXDepartment of Neurology Texas Tech University Health Sciences Center El Paso TXDepartment of Neurology St. Vincent Medical Center Toledo OHDepartment of Neurosurgery University of Texas Medical Branch (UTMB) Galveston TXDepartment of Neurology, SSM Health DePaul Hospital St. Louis MODepartment of Neurosurgery State University of New York at Buffalo's Jacobs School of Medicine and Biomedical Sciences New York NYDepartment of Neurology Ascension Health and University of Illinois Chicago (UIC) Chicago ILDepartment of Neurosurgery University of Utah Salt Lake City UTDepartment of Neurosurgery University of Illinois Chicago (UIC) Chicago ILDepartment of Neurosurgery University of Illinois Chicago (UIC) Chicago ILDepartment of Neurology Rush University Medical Center Chicago ILDepartment of Neurology Texas Tech University Lubbock TXDepartment of Neurosurgery Baylor St. Lukes Medical Center Houston TXDepartment of Neurology Valley Baptist Medical Center Brownsville TXDepartment of Neurology Texas Tech University Health Sciences Center El Paso TXDepartment of Neurology Texas Tech University Health Sciences Center El Paso TXDepartment of Neurosurgery University Hospital Missouri Columbia MODepartment of Neurosurgery University Hospital Missouri Columbia MOInternal Medicine HCA Houston Kingwood/University of Houston College of Medicine KingwoodDepartment of Clinical Sciences HCA Houston Healthcare Kingwood Kingwood TXDepartment of Clinical Sciences HCA Houston Healthcare Kingwood Kingwood TXDepartment of Neurology St. Vincent Medical Center Toledo OHDepartment of Neurosurgery University Hospital Missouri Columbia MOBackground Multiple studies have highlighted the importance of carotid artery stenting (CAS) operator's experiences. However, fellowship‐trained neurointerventionalists remain an under‐represented specialty in the literature. We aim to report the complication rate of CAS performed exclusively by neurointerventionalists. Methods Retrospective cohort study regarding stenting symptomatic and asymptomatic carotid stenosis was collected at multiple comprehensive stroke centers. The primary outcome included a composite of the 30‐day periprocedural mortality, symptomatic ischemic stroke, symptomatic intracranial hemorrhage, and myocardial infarction. The secondary outcomes included other complications. Chi‐squared tests were performed for categorical variables, and Welch's t‐test was used for continuous variables. Cutoffs in continuous variables were estimated using grid search optimization. Sensitivity analyses were performed for missing data. Results Between 2018 and 2022, 1445 CAS procedures were performed by 38 neurointerventionalists. We have 30‐day outcome data on 1281 patients. Patients were predominantly symptomatic (93.01%), male (65.79%), White (70.36%), and had a median age of 69. The primary outcomes occurred in 26 (1.8%) cases, with 13 (0.9%) death, 8 (0.55%) symptomatic ischemic stroke, 4 (0.28%) symptomatic intracranial hemorrhage, and 1 (0.07%) myocardial infarction. A statistically significant increase in all outcomes correlated with advanced age (P = 0.001), women (P = 0.013), aortic arch type 3 (P = 0.01), and higher preprocedural modified Rankin score (P = 0.006). Secondary outcomes were higher in Hispanic and Black patients (P = 0.007) and those with low diastolic blood pressure at stenting (P = 0.04). Conclusion CAS, conducted by fellowship‐trained neurointerventionalist physicians in comprehensive stroke centers, demonstrates a lower complication rate than what was previously reported in CAS, carotid endarterectomy, and transcarotid artery revascularization literature. Physician training, higher frequency, and standardized stroke care in a comprehensive stroke center may contribute to this low complication rate.https://www.ahajournals.org/doi/10.1161/SVIN.124.001459carotid artery stenosiscarotid artery stentingcomplicationsneurointerventional surgeon |
| spellingShingle | Mohamad Ezzeldin Ameer E. Hassan Ali Kerro Maria Martucci Muhammad Shazam Hussain Osman Mir Faheem G. Sheriff Peter Kan Chizoba Ezepue Nazli A. Janjua Kaiz S. Asif Ramesh Grandhi Ali Alaraj Muhammad Niazi Ossama Yassin Mansour Michael Chen Saif Bushnaq Omar Tanweer Adnan H. Siddiqui Adam Delora Rime Ezzeldin Bains Navpreet Varun Chaubal Mohammad Ammar Abdulrazzak Hamzah Saei Gustavo J. Rodriguez Mohammad AlMajali Gautam Edhayan Amer Al Shekhlee Christopher Hadjialiakbari Musaab Froukh Walid K. Salah Elsa Nico Adrusht Madapoosi Yazan Radiaideh Darko Quispe‐Orozco Oz Haim Noel Garza Alberto Maud Morgan Rolon‐Newton Benan Barakat Tejas Gowda Muhammad Monk Zuhair Ali Tunmi Anwoju Osama O. Zaidat Farhan Siddiq Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI) Stroke: Vascular and Interventional Neurology carotid artery stenosis carotid artery stenting complications neurointerventional surgeon |
| title | Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI) |
| title_full | Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI) |
| title_fullStr | Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI) |
| title_full_unstemmed | Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI) |
| title_short | Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI) |
| title_sort | carotid artery stenting outcomes by neurointerventional surgeons casoni |
| topic | carotid artery stenosis carotid artery stenting complications neurointerventional surgeon |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.124.001459 |
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