Τίτλος:
Risk of perioperative neck hematoma in TIA and non-disabling stroke patients with symptomatic carotid artery stenosis undergoing endarterectomy within 14 days from cerebrovascular event.
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Backround & purpose: Perioperative neck hematoma (PNH) requiring re-intervention is an important complication after carotid endarterectomy (CEA). There are limited data regarding the potential risk factors associated with PNH. The aim of this prospective, multicenter study was to document the rate of PNH in symptomatic carotid artery stenosis (sCAS) patients treated with CEA within the first 14 days of cerebrovascular symptom onset and to identify possible predictors of this complication. Methods: Patients with non-disabling (mRS ≤ 2) acute ischemic stroke or transient ischemic attack due to sCAS (≥70%) underwent CEA at three stroke-centers during a seven-year period. PNH requiring surgical re-intervention or transfusion during a 30-day follow-up period was determined by the attending surgeon but was also confirmed by an independent neurologist. Results: A total of 280 patients with sCAS underwent CEA within 14 days of ictus. PNH occurred in 10 cases (3.6%; 95%CI: 1.4%–5.8%). Pretreatment with therapeutic anticoagulation (TA) and history of atrial fibrillation were more prevalent in patients with PNH (20% vs. 3.1%, p= 0.047 & 30% vs. 8.2%, p = 0.05 respectively). Elapsed time between symptom onset and carotid surgery, pretreatment with dual antiplatelets, intravenous thrombolysis or prophylactic anticoagulation were not related to PNH in univariable analyses. Pretreatment with TA was independently associated with higher likelihood of PNH [OR: 10.69, 95%CI (1.74–65.72), p = 0.011] in multivariate logistic regression models adjusting for potential confounders. Conclusion: PNH is uncommon in patients with sCAS that are operated during the first 14 days of ictus. Pretreatment with TA appears to be associated with higher risk of PNH. © 2019 Elsevier B.V.
Συγγραφείς:
Roussopoulou, A.
Lazaris, A.
Tsivgoulis, G.
Krogias, C.
Moulakakis, K.
Georgiadis, G.S.
Kakisis, J.D.
Zompola, C.
Faissner, S.
Palaiodimou, L.
Theodorou, A.
Hummel, T.
Safouris, A.
Matsota, P.
Zervas, P.
Triantafyllou, S.
Voumvourakis, C.
Lazarides, M.
Geroulakos, G.
Vasdekis, S.N.
Περιοδικό:
Journal of the Neurological Sciences
Λέξεις-κλειδιά:
anticoagulant agent; antivitamin K; fibrinolytic agent; low molecular weight heparin; anticoagulant agent, aged; anticoagulant therapy; Article; atrial fibrillation; blood transfusion; brain ischemia; carotid artery obstruction; carotid endarterectomy; cohort analysis; confounding variable; deep vein thrombosis; dual antiplatelet therapy; elapsed time; female; fibrinolytic therapy; follow up; head and neck disease; hematoma; heparinization; high risk patient; human; independent variable; major clinical study; male; medical history; neurologist; neurosurgeon; observational study; perioperative neck hematoma; peroperative complication; predictor variable; prevalence; priority journal; prophylaxis; prospective study; reoperation; risk factor; stroke patient; surgical risk; symptom; thrombosis prevention; time; transient ischemic attack; adverse event; carotid artery obstruction; carotid endarterectomy; cerebrovascular accident; cerebrovascular disease; clinical trial; diagnostic imaging; hematoma; middle aged; multicenter study; postoperative complication; time factor; transient ischemic attack; very elderly, Aged; Aged, 80 and over; Anticoagulants; Carotid Stenosis; Cerebrovascular Disorders; Endarterectomy, Carotid; Female; Hematoma; Humans; Ischemic Attack, Transient; Male; Middle Aged; Postoperative Complications; Prospective Studies; Risk Factors; Stroke; Time Factors
DOI:
10.1016/j.jns.2019.116590
