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Postoperative outcomes in patients with anemia undergoing carotid revascularization

Ahmed Abdelkarim1, Sabrina L Straus1, Marjan Moghaddam1

  • 1Division of Vascular & Endovascular Surgery, Department of Surgery, Center for Learning and Excellence in Vascular and Endovascular Surgery, UC San Diego, San Diego, CA.

Journal of Vascular Surgery
|August 23, 2024
PubMed

Insights

Transcarotid artery revascularization (TCAR) shows improved outcomes for anemic patients undergoing carotid procedures. TCAR is linked to lower mortality and major adverse cardiac events compared to transfemoral carotid artery stenting (TFCAS) and carotid endarterectomy (CEA).

Area of Science:

  • Vascular Surgery
  • Cardiovascular Interventions
  • Anemia Management

Background:

  • Preoperative anemia is a known risk factor for adverse outcomes following major vascular surgery.
  • Optimal carotid revascularization strategies for anemic patients remain under-researched.
  • This study addresses the comparative effectiveness of different carotid revascularization methods in anemic patients.

Purpose of the Study:

  • To compare 30-day mortality and in-hospital major adverse cardiac events (MACE) after carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR) in patients with anemia.
  • To identify the safest and most effective carotid revascularization technique for anemic individuals.

Main Methods:

  • Retrospective analysis of the Vascular Quality Initiative database (2016-2023).
  • Inclusion of patients with anemia, defined as hemoglobin <13 g/dL (men) or <12 g/dL (women).
  • Multivariate logistic regression models were employed to analyze primary outcomes: 30-day mortality and in-hospital MACE.

Main Results:

  • The study analyzed 40,383 CEA, 9,159 TFCAS, and 18,555 TCAR cases in anemic patients.
  • TCAR demonstrated significantly lower 30-day mortality (aOR 0.45) and MACE (aOR 0.58) compared to TFCAS.
  • TCAR showed a trend towards lower 30-day mortality (aOR 0.80) versus CEA, with similar MACE rates.
  • TFCAS was associated with increased 30-day mortality (aOR 2.0) and MACE (aOR 1.7) compared to CEA.

Conclusions:

  • Transfemoral carotid artery stenting (TFCAS) is associated with higher risks of mortality and MACE in anemic patients compared to CEA and TCAR.
  • Transcarotid artery revascularization (TCAR) offers a lower risk of 30-day mortality compared to CEA in this population.
  • TCAR emerges as a potentially optimal minimally invasive option for carotid revascularization in patients with anemia.
Abstract

Keywords:
Carotid endarterectomyCarotid revascularizationFlow reversalPreoperative anemiaTranscarotid artery revascularizationTransfemoral carotid artery stenting

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