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The Effect Of Calcium Burden (circumference, Thickness, Length) On The Early And Late Outcome Of Tcar
Ali AbuRahma, M.D.,
Noah Dargy, MD, Adrian Santini, MD, Zachary AbuRahma, DO, Samuel Booth, MD, Matthew Dietz, MD, Scott Dean, PhD, MBA, Robert Cragon, MD, Elaine Mattox, RN, Ed.D.
Charleston Area Medical Center, Charleston, WV, USA.
BACKGROUND: Transfemoral carotid stenting has been associated with increased risk in heavy calcified lesions. Therefore, this study will analyze the effect of calcium burden (percentage of circumference calcification, thickness, and/or the length) on TCAR early and late outcome.
METHODS: This is a retrospective review of prospectively collected data of patients who had TCAR in our institution. Preoperative CTAs were reviewed to determine three calcium variables: 1. circumferential calcification; 2. calcification thickness in mm; and 3. lesion length calcification. Primary outcome was 30-day perioperative stroke/death rate, while secondary outcome included 30-day stroke, death, and MI rate. Late outcome included stroke/death rate and late in-stent restenosis. Kaplan Myer Analysis was used to estimate freedom of stroke, stroke and death, and ≥50% restenosis rates according to calcium classification.
RESULT: This study analyzed 313 procedures with a mean age of 71 years and mean follow-up of 29.4 months (1 month – 108 months). Circumference calcification: 0-50% in 62% and 51-100% in 38%; calcification thickness: ≤2mm in 49% and >2mm in 51% while calcification length: <20mm in 50%, and ≥20mm in 50%. The overall 30-day perioperative stroke rate was 2.0% and stroke/death/MI of 3.5%. The 30-day perioperative stroke rate according to calcium circumference (≤50% vs >50%) was 1.7% vs 2.9% (p 0.674); length (<20mm vs ≥20mm) was 2.1% vs 2.2% (p 1); and thickness (≤2mm vs >2mm) was 1.5% vs 2.9% (p 0.6841). The combined early and late stroke rates for calcium circumference (≤50% vs >50%): 4.2% vs 4.9% (p 0.771); length (<20mm vs ≥20mm) 6% vs 3% (p 0.242); and thickness (≤2mm vs >2mm): 3.8% vs 5.2% (p 0.599). Rates for >50% restenosis for calcium circumference (≤50% vs >50%) 7.9% vs 8.8% (p 0.821); length (<20mm vs ≥20mm) 7.5% vs 9.0% (p 0.663); and thickness (≤2mm vs >2mm) 7.6% vs 8.8% (p 0.825). Kaplan Myer Analysis showed that the rates of freedom from stroke, stroke and death, and ≥50% restenosis at 1, 2, and 3 years according to calcification circumference, thickness, and length were similar. (Table 1)
CONCLUSION: This study showed no significant effect of calcium burden on TCAR early and late outcomes.
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