Carotid Artery Stenosis with Acute XXXX : Stenting versus Angioplasty.

@entity1 @entity64 @entity1188 @entity850 @entity543 @entity385
BACKGROUND: When a @entity1 with @entity543 presents emergently with acute @entity385 , the optimum treatment plan is not clearly defined. If intervention is warranted, and open surgery is prohibitive, endovascular revascularization may be performed. The use of stents places the @entity1 at additional risk due to their thrombogenic potential. The intent of this study was to compare outcomes following endovascular approaches (angioplasty alone vs. stent) in the setting of @entity64 . METHODS: We extracted a population from the National Inpatient Sample (2012) and the Nationwide Inpatient Sample (2003-2011) composed of @entity1 with @entity543 with @entity1188 that were admitted nonelectively and received endovascular revascularization. @entity1 treated with mechanical thrombectomy or thrombolysis were excluded. Categorical variables were compared between treatment groups with Chi-squared tests. Binary logistic regression was performed to evaluate mortality and @entity64 while controlling for age, case severity, and comorbidity burden. RESULTS: About 6,333 admissions met our criteria. A majority were treated via stenting (89%, n = 5,608). The angioplasty-alone group had significantly higher mortality (9.0% vs. 3.8%, p < 0.001) and @entity64 rate (3.9% vs. 1.9%, p < 0.001) than the stent group. The adjusted odds ratios of mortality and @entity64 for @entity1 treated with angioplasty alone were 1.953 (p < 0.001) and 1.451 (p = 0.105), respectively, in comparison to @entity1 treated with carotid stenting. CONCLUSION: Multivariate analysis found the risk of mortality to be elevated following angioplasty alone. This may represent selection bias, but it also may indicate that symptomatic @entity1 with @entity64 suffer from severe @entity850 and unstable plaques that would benefit from stent placement. These results would caution angioplasty alone as an arm of a future randomized trial involving this severely burdened @entity1 population requiring urgent intervention.
