Gender And Race Based Outcomes Of Trans-carotid Artery Revascularization
Isibor Arhuidese, MD MPH1, Erin K. Baldwin1, Isaac Naazie, MD MPH2, Mahmoud B. Malas, MD MHS2, Charles J. Bailey, MD1, Neil Moudgill, MD1, Mary E. Ottinger, MD1, Murray L. Shames, MD1.
1University of South FLorida, Tampa, FL, USA, 2University of California San Diego, San Diego, CA, USA.
Objective: Trans carotid artery revascularization (TCAR) has become popular as a low risk alternative for the treatment of carotid artery stenosis. However, the relative performance of this procedure within categories of gender and race is undescribed.
Methods: We studied all patients in the Vascular Quality Initiative who underwent TCAR with flow reversal between January-2016 and December-2019. Absolute and multivariable risk adjusted logistic regression were employed to evaluate new peri-procedural ipsilateral stroke, myocardial infarction (MI), death as well as the composites of 30-day stroke/death and 30-day stroke/death/MI.
Results: Of the 5631 patients who underwent TCAR, 3654 (65%) were male and 1977 (35%) were female. There were 5129 (91.2%) white, 254 (4.5%) Black and 244 (4.3%) patients classified as other race. The prevalence of carotid symptoms was similar comparing males vs females: 33.1 vs 35.1% (p=0.14) and Whites vs Blacks: 33.5 vs 36.6% (p=0.25). Peri-procedural stroke was 1.3 vs 1.1% comparing males versus females (p=0.52) and 1.2 vs 2.4% (p=0.19) comparing Whites vs Blacks. There was no significant difference in the absolute outcomes: 30-day mortality, MI, 30-day stroke/death and well as 30-day stroke/death/MI between the groups (table 1). The risk adjusted analyses showed no significant difference in 30-day stroke (aOR: 0.8; 95%CI: 0.47-1.36; p=0.41), as well as 30-day stroke/death (aOR: 0.97; 95%CI: 0.63-1.50; p=0.90) for females relative to males. There was also no significant difference in 30-day stroke (aOR: 2.0; 95%CI: 0.83-4.81; p=0.12) or 30-day stroke/death (aOR: 1.89; 95%CI: 0.89-4.04; p=0.098) for Blacks compared to
White patients. The similarity between categories of gender and race persisted within strata of carotid symptoms.
Conclusions: In this large study of patients who underwent TCAR, there was no significant difference in outcomes of TCAR for females relative to males and for Blacks relative to white patients. Hence, the safety profile of this novel procedure is consistent regardless of gender and the categories of race studied.
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