Journal Mobile Options
Table of Contents
Vol. 69, No. 5, 2013
Issue release date: May 2013
Eur Neurol 2013;69:263-269
(DOI:10.1159/000346000)

Diabetes Does not Affect Outcome of Symptomatic Carotid Stenosis Treated with Endovascular Techniques

Lago A. · Parkhutik V. · Tembl J.I. · Bermejo A. · Aparici F. · Mainar E. · Vázquez-Añón V.
Departments of aNeurology, bRadiology, Hospital Universitari la Fe, Valencia, Spain

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: The influence of diabetes on carotid revascularization techniques is controversial, with few data regarding angioplasty and stenting (CAS). Our purpose was to analyze whether its presence constitutes a risk factor for poor outcome of patients with carotid stenosis treated with CAS. Methods: We compared 30-day and long term morbidity and mortality, as well as restenosis rates, of non diabetic and diabetic patients with symptomatic carotid stenosis treated with endovascular techniques. Results: 318 consecutive patients, 116 (36.5%) of them diabetics, were followed for a median of 56 months. Cumulative 30-day stroke, ischemic cardiopathy and death rate was 4% for non diabetics and 5.2% for diabetics (non significant). Long term stroke and mortality rate was 26.4% for the first group and 34.3% for the second (non significant). The most frequent causes of death were myocardial infarction (17.5% non diabetics, 44% diabetics, p = 0.04), ischemic stroke (12.5% non diabetics, 4% diabetics, non significant) and cancer (30% non diabetics, 16% diabetics, non significant). Twelve patients (6.4%) had restenosis ≥50%, 5.9% non diabetic, 7.4% diabetic, also without statistical significance. Conclusions: In our series, endovascular treatment is both efficient and safe in diabetic patients with symptomatic carotid stenosis; therefore, the presence of diabetes mellitus did not increase the risks linked to CAS procedure.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Folsom AR, Rasmussen ML, Chambless LE, Howard G, Cooper LS, Schmidt MI, Heiss G: Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care1999;22:1077-1083.
  2. Mukherjee D: Peripheral and cerebrovascular atherosclerotic disease in diabetes mellitus. Best Prac Res Clin Endocrinol Metab 2009;23:335-345.
  3. Dorigo W, Pulli R, Pratesi G, Fargion A, Marek J, Innocenti AA, Pratesi C: Early and long-term results of carotid endarterectomy in diabetic patients. J Vasc Surg 2011;53:44-52.
  4. Lago A, Aparici-Robles F, Parkhutik V, Tembl JI, Mainar E, Vázquez-Añón V, Claramonte B: [Long-term development of carotid stenosis treated by endovascular means: a prospective study in a neurovascular unit]. Rev Neurol 2011;53:538-544.

    External Resources

  5. NASCET Investigators: North American Symptomatic Carotid Endarterectomy Trial: methods, patient characteristics, and progress. Stroke 1991;22:711-720.
  6. Lago A, Parkhutik V, Tembl JI, Aparici F, Mainar E, Alcalá C, Vázquez-Añón V, et al: Long-term outcome in patients with carotid artery stenting and contralateral carotid occlusion: a single neurovascular center prospective analysis. Neuroradiology DOI: 10.1007/s00234-011-0974-8, in press.
  7. Parkhutik V, Lago A, Tembl JI, Aparici F, Vazquez V, Mainar E: Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treat. Eur J Neurol 2009;17:267-272.
  8. Gurm HS, Jay S, Yadav JS, Katzen BT, Mishkel GJ, Bajwa TK, Ansel G, Strickman NE, Wang H, Cohen SA, Massaro JM, Cutlip DE; for the SAPPHIRE Investigators: Long-Term Results of Carotid Stenting versus Endarterectomy in High-Risk Patients. N Engl J Med 2008;358:1572-1579.
  9. Fortea G, Fages E, Tembl JI, Boscá I, Lago A: [Quality control of Doppler diagnoses in Vascular Neurology]. Rev Neurol 2003;37:627-631.

    External Resources

  10. Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, Halperin JL, Johnston SC, Katzan I, Kernana WN, Mitchell PH, Ovbiagele B, Palesh YY, Sacco RL, Schwamm LH, Wassertheil-Smoller S, Turan TN, Wentworth D; and on behalf of the American Heart Association Stroke Council: Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the Heart Association/American Stroke Association. Stroke 2011;42;227-276.
  11. Stoner MC, Abbott WM, Wong DR, Hua HT, Lamuraglia GM, Kwolek CJ, Watkins MT, Agnihotri AK, Henderson WG, Khuri S, Cambria RP: Defining the high-risk patient for carotid endarterectomy: an analysis of the prospective National Surgical Quality Improvement Program database. J Vasc Surg 2006;43:285-295.
  12. Yuo TH, Goodney PP, Powell RJ, Cronenwett JL: ‘Medical high risk' designation is not associated with survival after carotid artery stenting. J Vasc Surg 2008:47:356-362.
  13. Axelrod DA, Upchurch GR Jr, DeMonner S, Stanley JC, Shukri Khuri S, Jennifer Daley J, Henderson WG, Hayward, R: Perioperative cardiovascular risk stratification of patients with diabetes who undergo elective major vascular surgery. J Vasc Surg 2002;35:894-901.
  14. Kim JS, Choi-Kwon S: Risk Factors for Stroke in Different Levels of Cerebral Arterial Disease. Eur Neurol 1999;42:150-156.
  15. Virkkunen J, Heikkinen M, Lepantalo M, Metsänoja R, AffiliationsSalenius JP; Finnvasc Study Group: Diabetes as an independent risk factor for early postoperative complications in critical limb ischemia. Vasc Surg 2004;40:761-767.
  16. Aziz I, Lewis R, Baker JD, de Virgilio C: Cardiac morbidity and mortality following carotid endarterectomy: the importance of diabetes and multiple risk factors. Ann Vasc Surg 2001;15:243-246.
  17. Ahari A, Bergqvist D, Troëng T, Elfström J, Hedberg B, Ljungström KG, Norgren L, Örtenwall P: Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy-a population-based study. Eur J Vasc Endovasc Surg 1999;18:122-126.
  18. Schlüter M, Reimers B, Castriota F,Tübler T, Cernetti C, Cremonesi A, Berger J, Colombo A, Schofer J: Impact of diabetes, patient age, and gender on the 30-day incidence of stroke and death in patients undergoing carotid artery stenting with embolus protection: a post-hoc subanalysis of a prospective multicenter registry. J Endovasc Ther 2007;14:271-278.
  19. Akbari CM, Pomposelli FB Jr, Gibbons GW, Campbell DR, Freeman DV, LoGerfo FW: Diabetes mellitus: a risk factor for carotid endarterectomy? J Vasc Surg 1997;25:1070-1075.
  20. Pistolese GR, Appolloni A, Ronchey S, Martelli E: Carotid endarterectomy in diabetic patients. J Vasc Surg 2001;33:148-154.
  21. Ballotta E, Da Giau G, Renon L: Is diabetes mellitus a risk factor for carotid endarterectomy? A prospective study. Surgery 2001;129:146-152.
  22. Rockman CB, Saltzberg SS, Maldonado TS, Adelman MA, Cayne NS, Lamparello PJ, Riles TS: The safety of carotid endarterectomy in diabetic patients: clinical predictors of adverse outcome. J Vasc Surg 2005;42:878-883.
  23. Halm EA, Tuhrim S, Wang JJ, Rockman C, Riles TS, Chassin MR: Risk factors for perioperative death and stroke after carotid endarterectomy: results of the New York Carotid Artery Surgery Study. Stroke 2009;40:221-229.
  24. Tu JV, Wang H, Bowyer B, Green L, Fang J, Kucey D; Participants in the Ontario Carotid Endarterectomy Registry: Risk factors for death or stroke after carotid endarterectomy: observations from the Ontario Carotid Endarterectomy Registry. Stroke 2003;34:2568-2573.
  25. McGirt M, Woodworth GF, Brooke BS, Coon AL, Jain S, Buck D, Huang J, Clatterbuck RE, Tamargo RJ, Perler BA: Hyperglycemia Independently Increases the Risk of Perioperative Stroke, Myocardial Infarction, and Death after Carotid Endarterectomy. Neurosurgery 2006;58:1066-1073.
  26. Protack CD, Bakken AM, Xu J, Saad WA, Lumsden AB, Davies MG: Metabolic syndrome: A predictor of adverse outcomes after carotid revascularization. J Vasc Surg 2009;49:1172-1180.
  27. Parlani G, De Rango P, Cieri E, Verzini F, Giordano G, Simonte G, Isernia G, Cao P: Diabetes is not a predictor of outcome for carotid revascularization with stenting as it may be for carotid endarterectomy. J Vasc Surg 2012;55:79-89.
  28. Brott TG, Hobson RW, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF; CREST Investigators: Stenting versus endarterectomy for treatment of carotid-artery stenosis. N EnglJ Med 2010;363:11-23.
  29. Pendlebury ST, Rothwell PM: Risk of Recurrent Stroke, Other Vascular Events and Dementia after Transient Ischaemic Attack and Stroke. Cerebrovasc Dis 2009;27(suppl 3):1-11.
  30. Anderson H V, Rosenfield K A, White CJ, Ho KKL, Spertus JA, Jones PG, Tang F, Cates CU, Jaff M R, Koroshetz W J, Katzan I L, Hopkins LN, Rumsfeld JS, Brindis RG: Clinical features and outcomes of carotid artery stenting by clinical expert consensus criteria: A report from the CARE registry. Catheter Cardiovasc Interv 2010;75:519-525.
  31. Paciaroni M, Bogousslavsky J: Primary and Secondary Prevention of Ischemic Stroke. Eur Neurol 2010;63:267-278.
  32. Reina-Gutiérrez T, Serrano-Hernando FJ, Sánchez-Hervás L, Ponce A, Vega de Ceniga M, Martín A: Recurrent carotid artery stenosis following endarterectomy: natural history and risk factors. Eur J Vasc Endovasc Surg 2005;29:334-341.
  33. Fluri F, Engelter ST, Wasner M, Stierli P, Merlo A, Lyrer PA: The Probability of Restenosis, Contralateral Disease Progression, and Late Neurologic Events following Carotid Endarterectomy: A Long-Term Follow-Up Study. Cerebrovasc Dis 2009;27(suppl 1):134-139.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50