Calcified Plaque Volume as a Predictor of Combined Stroke and Death After Transcarotid Artery Revascularization

• DOI: 10.1016/j.jvs.2024.03.042
• Publication Date: 2024-05-20T06:26:35Z
• Authors: Leanne Grafmuller; Daniel J. Lehane; Michael C. Stoner; Karina Newhall; Christian Dohring; Jonathan Zou
• Keywords: Stroke

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