Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease
Objective: Chronic kidney disease (CKD) is associated with cerebrovascular diseases (CVDs) due to chronic systemic inflammation. This study aimed to estimate perioperative and long-term outcomes in Chinese patients undergoing carotid artery stenting (CAS) who had different stages of CKD. Method: Thi...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-12-01
|
| Series: | Thrombosis Update |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266657272400035X |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846115701955231744 |
|---|---|
| author | Qiaoming Jiang Jiangkai Yu Yutao Zhao Bichao Wang Xixiang Gao Yingchun Xiao |
| author_facet | Qiaoming Jiang Jiangkai Yu Yutao Zhao Bichao Wang Xixiang Gao Yingchun Xiao |
| author_sort | Qiaoming Jiang |
| collection | DOAJ |
| description | Objective: Chronic kidney disease (CKD) is associated with cerebrovascular diseases (CVDs) due to chronic systemic inflammation. This study aimed to estimate perioperative and long-term outcomes in Chinese patients undergoing carotid artery stenting (CAS) who had different stages of CKD. Method: This retrospective study enrolled 888 patients undergoing CAS for carotid artery stenosis. Patients were classified into normal, mild, moderate, and severe CKD and dialysis groups based on their renal function. The primary endpoint was long-term survival from a major adverse event (MAE), which was predefined as the development of a stroke, myocardial infarction (MI), or death during a 10-year long-term follow-up. Results: Perioperative rates for MAE were 1.5 %, 1.8 %, 3.0 %, 10.3 %, and 9.1 % for the five categories (p < 0.001). There was no death within the perioperative 30 days. The estimated 5-year death-free survival rates decreased with worsening renal function (92.2 % vs. 82.7 % vs. 76.9 % vs. 61.4 % vs. 58.6 %, p < 0.001). The long-term MAE-free survival was 94.7 % vs. 91.0 % vs. 80.2 % vs. 63.7 % vs. 52.2 % for the groups, with the differences being significant between normal to moderate CKD and severe CKD and hemodialysis-dependent cases. Cox regression analysis revealed that dialysis (HR = 3.216 (95%CI: 1.662, 6.223), p = 0.001), severe CKD (HR = 4.592 (95%CI: 2.348, 8.982), p < 0.001), hypertension (HR = 1.977 (95%CI: 1.292, 3.024), p = 0.002), coronary artery disease (HR = 1.509 (95%CI: 1.037, 2.196), p = 0.032) and diabetes mellitus (HR = 2.459 (95%CI: 1.482, 4.079), p < 0.001) were predictors of long-term MAE after CAS. Conclusion: Risk of perioperative and long-term MAE increased with CKD severity. Patients with normal to moderate CKD benefited from MAE-free survival after CAS. However, preventive CAS appeared to be inappropriate in severe CKD or hemodialysis cases with asymptomatic carotid stenosis, particularly in those with a number of comorbidities. |
| format | Article |
| id | doaj-art-d8dbc1eebeff46959db5719f3da7dd8f |
| institution | Kabale University |
| issn | 2666-5727 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Thrombosis Update |
| spelling | doaj-art-d8dbc1eebeff46959db5719f3da7dd8f2024-12-19T11:00:53ZengElsevierThrombosis Update2666-57272024-12-0117100193Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney diseaseQiaoming Jiang0Jiangkai Yu1Yutao Zhao2Bichao Wang3Xixiang Gao4Yingchun Xiao5Department of Nephrology, Jiangsu Taizhou People's Hospital Affiliated to Nanjing Medical University, No. 366 Taihu Street, Medical High-tech Zone, Taizhou City, Jiangsu Province, 225399, ChinaDepartment of Clinical Medicine, Southeast University School of Medicine, No. 87 Dingjiaqiao, Gulou District, Nanjing City, Jiangsu Province, 211189, ChinaJiangsu Taizhou People's Hospital Affiliated to Nanjing Medical University, ChinaDepartment of Operating Room, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, No. 123 Tianfei Lane, Mochou Road, Nanjing City, Jiangsu Province, 210004, China; Corresponding author.Department of Vascular Surgery, Beijing Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China; Corresponding author.Department of Nephrology, Jiangsu Taizhou People's Hospital Affiliated to Nanjing Medical University, No. 366 Taihu Street, Medical High-tech Zone, Taizhou City, Jiangsu Province, 225399, China; Corresponding author.Objective: Chronic kidney disease (CKD) is associated with cerebrovascular diseases (CVDs) due to chronic systemic inflammation. This study aimed to estimate perioperative and long-term outcomes in Chinese patients undergoing carotid artery stenting (CAS) who had different stages of CKD. Method: This retrospective study enrolled 888 patients undergoing CAS for carotid artery stenosis. Patients were classified into normal, mild, moderate, and severe CKD and dialysis groups based on their renal function. The primary endpoint was long-term survival from a major adverse event (MAE), which was predefined as the development of a stroke, myocardial infarction (MI), or death during a 10-year long-term follow-up. Results: Perioperative rates for MAE were 1.5 %, 1.8 %, 3.0 %, 10.3 %, and 9.1 % for the five categories (p < 0.001). There was no death within the perioperative 30 days. The estimated 5-year death-free survival rates decreased with worsening renal function (92.2 % vs. 82.7 % vs. 76.9 % vs. 61.4 % vs. 58.6 %, p < 0.001). The long-term MAE-free survival was 94.7 % vs. 91.0 % vs. 80.2 % vs. 63.7 % vs. 52.2 % for the groups, with the differences being significant between normal to moderate CKD and severe CKD and hemodialysis-dependent cases. Cox regression analysis revealed that dialysis (HR = 3.216 (95%CI: 1.662, 6.223), p = 0.001), severe CKD (HR = 4.592 (95%CI: 2.348, 8.982), p < 0.001), hypertension (HR = 1.977 (95%CI: 1.292, 3.024), p = 0.002), coronary artery disease (HR = 1.509 (95%CI: 1.037, 2.196), p = 0.032) and diabetes mellitus (HR = 2.459 (95%CI: 1.482, 4.079), p < 0.001) were predictors of long-term MAE after CAS. Conclusion: Risk of perioperative and long-term MAE increased with CKD severity. Patients with normal to moderate CKD benefited from MAE-free survival after CAS. However, preventive CAS appeared to be inappropriate in severe CKD or hemodialysis cases with asymptomatic carotid stenosis, particularly in those with a number of comorbidities.http://www.sciencedirect.com/science/article/pii/S266657272400035XChronic kidney diseaseCarotid artery stentingStrokeMajor adverse eventLong-term survival |
| spellingShingle | Qiaoming Jiang Jiangkai Yu Yutao Zhao Bichao Wang Xixiang Gao Yingchun Xiao Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease Thrombosis Update Chronic kidney disease Carotid artery stenting Stroke Major adverse event Long-term survival |
| title | Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease |
| title_full | Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease |
| title_fullStr | Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease |
| title_full_unstemmed | Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease |
| title_short | Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease |
| title_sort | long term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease |
| topic | Chronic kidney disease Carotid artery stenting Stroke Major adverse event Long-term survival |
| url | http://www.sciencedirect.com/science/article/pii/S266657272400035X |
| work_keys_str_mv | AT qiaomingjiang longtermsurvivalandcerebrovasculareventsaftercarotidarterystentinginpatientswithchronickidneydisease AT jiangkaiyu longtermsurvivalandcerebrovasculareventsaftercarotidarterystentinginpatientswithchronickidneydisease AT yutaozhao longtermsurvivalandcerebrovasculareventsaftercarotidarterystentinginpatientswithchronickidneydisease AT bichaowang longtermsurvivalandcerebrovasculareventsaftercarotidarterystentinginpatientswithchronickidneydisease AT xixianggao longtermsurvivalandcerebrovasculareventsaftercarotidarterystentinginpatientswithchronickidneydisease AT yingchunxiao longtermsurvivalandcerebrovasculareventsaftercarotidarterystentinginpatientswithchronickidneydisease |