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Complications of Carotid Artery Stenting: A Real-World Cohort Study in Canada before and during the COVID-19 Pandemic

Published online by Cambridge University Press:  16 July 2025

Holly Sim Open the ORCID record for Holly Sim [Opens in a new window] ,
Kyra Steiner ,
Brian Dewar ,
Robert Fahed ,
Derek J. Roberts ,
Sophia Gocan Open the ORCID record for Sophia Gocan [Opens in a new window] ,
Nishita Singh ,
Santanu Chakraborty ,
Eduardo Portela de Oliveira  and
Dar Dowlatshahi Open the ORCID record for Dar Dowlatshahi [Opens in a new window]
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Holly Sim*
Affiliation:
Department of Medicine, University of Ottawa, Ottawa, Canada
Kyra Steiner
Affiliation:
Department of Medicine, University of Ottawa, Ottawa, Canada
Brian Dewar
Affiliation:
Ottawa Hospital Research Institute, Ottawa, Canada
Robert Fahed
Affiliation:
Department of Medicine, University of Ottawa, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada Department of Medical Imaging, Division of Radiology, University of Ottawa, Ottawa, Canada
Derek J. Roberts
Affiliation:
Ottawa Hospital Research Institute, Ottawa, Canada Department of Surgery and School of Epidemiology and Public Health, Division of Vascular and Endovascular Surgery, University of Ottawa, Ottawa, Canada
Sophia Gocan
Affiliation:
Department of Medicine, University of Ottawa, Ottawa, Canada
Nishita Singh
Affiliation:
Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, Canada Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
Santanu Chakraborty
Affiliation:
Ottawa Hospital Research Institute, Ottawa, Canada Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Canada
Eduardo Portela de Oliveira
Affiliation:
Ottawa Hospital Research Institute, Ottawa, Canada Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, Canada
Dar Dowlatshahi
Affiliation:
Department of Medicine, University of Ottawa, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada
Michel Shamy
Affiliation:
Department of Medicine, University of Ottawa, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada
*
Corresponding author: Holly Sim; Email: hsim@toh.ca
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Abstract:

Background and Objectives:

Although carotid endarterectomy (CEA) or carotid artery stenting (CAS) is recommended for symptomatic extracranial carotid stenosis of 50–99%, the COVID-19 pandemic significantly impacted resources. CAS therefore offered potential advantages as access to the angiosuite was seemingly easier than access to operating rooms. The primary objective was to determine the frequency of serious and non-serious complications following CAS before and during the COVID-19 pandemic.

Methods:

We performed a retrospective cohort study of consecutive patients who received CAS at the Ottawa Hospital, Canada, from June 2019 to May 2021. We reviewed baseline demographics, imaging, as well as intraprocedural and postprocedural complications based on chart review. We performed multivariable logistic regression to determine associations between clinical and safety outcomes.

Results:

We included 47 patients in the pre-pandemic period and 93 patients in the pandemic period (mean age = 70.4 years; 54% female; P = 0.287 for age and P = 0.962 for sex, respectively). The combined rate of intraprocedural and postprocedural serious complications (ischemic stroke, intracerebral hemorrhage, myocardial infarction or death) was 7.1%. Eight strokes occurred, and one patient with a postprocedural ischemic stroke died 11 days after stenting. Complication rates were similar before and during the pandemic (aOR 1.040, 95% CI 0.466–2.321). The number of referrals for CEA during the pandemic period decreased by 50%.

Conclusion:

In this cohort of consecutive patients undergoing CAS at a Canadian comprehensive stroke center before and during the COVID-19 pandemic, the rates of stroke and death were similar to pre-pandemic conditions and were generally consistent with the published literature.

Résumé :

RÉSUMÉ :

Les complications de l’implantation d’endoprothèse carotidienne : résultats d’une étude de cohorte en contexte réel au Canada avant et durant la pandémie de COVID 19.

Contexte et objectif :

L’endartériectomie carotidienne (EC) ou l’implantation d’endoprothèse carotidienne (IEC) sont toutes deux recommandées dans les cas de sténose de 50 à 99 % de la carotide extracrânienne, symptomatique, mais la pandémie de COVID 19 est venue bousculer l’utilisation des ressources. L’accès aux salles d’angiographie paraissant plus facile que celui aux salles d’opération, l’IEC présentait un avantage potentiel sur l’EC. L’étude visait donc principalement à déterminer la fréquence des complications graves et non graves de l’IEC avant et durant la pandémie de COVID 19.

Méthodes :

Il s’agit d’une étude de cohorte, rétrospective, de patients consécutifs qui ont subi une IEC à l’Hôpital d’Ottawa, au Canada, de juin 2019 à mai 2021. Un examen des dossiers médicaux a permis de recueillir des renseignements démographiques de base et des données sur les examens par imagerie ainsi que sur les complications peropératoires et postopératoires. C’est par régression logistique à plusieurs variables qu’ont été déterminées les associations entre les résultats cliniques et les résultats relatifs à l’innocuité.

Résultats :

L’étude repose sur les dossiers de 47 patients en phase de prépandémie et sur ceux de 93 patients en phase de pandémie (âge moyen = 70,4 ans; femmes = 54 %; âge : p = 0,287; sexe : p = 0,962, respectivement). Le taux cumulé de complications peropératoires et de complications postopératoires graves (accident ischémique, hémorragie cérébrale, infarctus du myocarde ou mort) s’élevait à 7,1 %. Il s’est produit 8 accidents vasculaires cérébraux [AVC] et 1 patient est mort d’un AVC ischémique postopératoire, 11 jours après l’IEC. Les taux de complication relevés avant et durant la pandémie étaient du même ordre de grandeur (risque relatif approché rajusté : 1,040; IC à 95 % : 0,466 2,321). Le nombre de demandes de consultation en spécialité pour une endartériectomie carotidienne a diminué de 50 % durant la pandémie.

Conclusions :

Les taux enregistrés d’accident vasculaire cérébral et de mort dans cette cohorte de patients consécutifs ayant subi une IEC dans un centre de soins intégrés de l’AVC au Canada, avant et durant la pandémie de COVID 19, se sont montrés comparables aux résultats enregistrés avant la pandémie, et ils étaient généralement concordants avec ceux publiés dans la documentation médicale.

Keywords

carotid artery diseasecarotid artery stentingcarotid revascularizationCOVID-19complications

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 9
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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References

Flaherty, ML, Kissela, B, Khoury, JC, Alwell, K, Moomaw, CJ, Woo, D, et al. Carotid artery stenosis as a cause of stroke. NED. 2013;40(1):36–41.Google ScholarPubMed
Cheng, SF, Brown, MM, Simister, RJ, Richards, T. Contemporary prevalence of carotid stenosis in patients presenting with ischaemic stroke. Br J Surg. 2019;106(7):872–878.10.1002/bjs.11136CrossRefGoogle ScholarPubMed
Flach, C, Muruet, W, Wolfe, CDA, Bhalla, A, Douiri, A. Risk and secondary prevention of stroke recurrence. Stroke. 2020;51(8):2435–2444.10.1161/STROKEAHA.120.028992CrossRefGoogle ScholarPubMed
Lovett, JK, Coull, AJ, Rothwell, PM. Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology. 2004;62(4):569–573.10.1212/01.WNL.0000110311.09970.83CrossRefGoogle ScholarPubMed
Kleindorfer, DO, Towfighi, A, Chaturvedi, S, Cockroft, KM, Gutierrez, J, Lombardi-Hill, D, et al. Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American heart association/American stroke association. Stroke. 2021;52(7):e364–e467.10.1161/STR.0000000000000375CrossRefGoogle ScholarPubMed
Gladstone, DJ, Lindsay, MP, Douketis, J, Smith, EE, Dowlatshahi, D, Wein, T, et al. Canadian stroke best practice recommendations: secondary prevention of stroke update 2020. Can J Neurol Sci. 2022;49(3):315–337.10.1017/cjn.2021.127CrossRefGoogle ScholarPubMed
Qureshi, AI, Agunbiade, S, Huang, W, Akhtar, IN, Abraham, MG, Akhtar, N, et al. Changes in neuroendovascular procedural volume during the COVID-19 pandemic: an international multicenter study. J Neuroimaging. 2021;31(1):171–179.10.1111/jon.12803CrossRefGoogle ScholarPubMed
Sterpetti, AV, Gabriele, R, Borrelli, V, Campagnol, M, Iannone, I, Costi, U, et al. Clinical outcomes for patients with cardiovascular diseases before, during, and after the COVID19 pandemic. A pooled analysis of 600.000 patients. Curr Prob Cardiol. 2024;49(6):102540.10.1016/j.cpcardiol.2024.102540CrossRefGoogle ScholarPubMed
Kabeil, M, Wohlauer, MV, D’Oria, M, Khetarpaul, V, Gillette, R, Moore, E, et al. Carotid artery operation delay during the Covid-19 pandemic: results of a multicenter international study. Ann Vasc Surg. 2023;96:44–56.10.1016/j.avsg.2023.05.041CrossRefGoogle ScholarPubMed
Crespy, V, Benzenine, E, Mariet, AS, Baudry, A, Bernard, C, Bejot, Y, et al. Impact of the first COVID-19 pandemic peak and lockdown on the interventional management of carotid artery stenosis in France. J Vasc Surg. 2022;75(5):1670–1678.e2.10.1016/j.jvs.2021.11.064CrossRefGoogle ScholarPubMed
Rinaldi, LF, Brioschi, C, Marazzi, G, Pallini, M, Marone, EM. Endovascular-first approach for symptomatic carotid artery stenosis in a COVID-19 positive patient: expected and unexpected advantages. Ann Vasc Surg. 2022;83:e1–e2.10.1016/j.avsg.2022.01.018CrossRefGoogle Scholar
Hellegering, J, Van Der Laan, MJ, Heide, EJD, Uyttenboogaart, M, Zeebregts, CJ, Bokkers, RPH. Preventing stroke in symptomatic carotid artery disease during the COVID-19 pandemic. J Vasc Surg. 2020;72(2):755–756.10.1016/j.jvs.2020.04.476CrossRefGoogle ScholarPubMed
Kiwan, R, Jukes, A, Mayich, M, Boulton, M, Sharma, M, Pelz, D, et al. A protocol for carotid artery stenting in COVID times. A single Canadian centre experience. Can J Neurol Sci. 2022;49(3):361–363.10.1017/cjn.2021.105CrossRefGoogle ScholarPubMed
Dowlatshahi, D, Stotts, G, Bourgoin, A, Gocan, S, Dunn, L, Powell, J, et al. Decreased stroke presentation rates at a comprehensive stroke center during COVID-19. Can J Neurol Sci. 2021;48(1):118–121.10.1017/cjn.2020.193CrossRefGoogle Scholar
The Ottawa Hospital. COVID-19 timeline: A year in review [Internet]. 2024. Available from: https://www.ottawahospital.on.ca/en/healthy-tomorrows/covid-19-timeline-a-year-in-review/.Google Scholar
North American symptomatic carotid endarterectomy trial. Methods, patient characteristics, and progress. Stroke. 1991;22(6):711–720.10.1161/01.STR.22.6.711CrossRefGoogle Scholar
Brott, TG, Hobson, RW, Howard, G, Roubin, GS, Clark, WM, Brooks, W, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. New Engl J Med. 2010;363(1):11–23.10.1056/NEJMoa0912321CrossRefGoogle ScholarPubMed
Müller, MD, Lyrer, P, Brown, MM, Bonati, LH. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Cochrane Db Syst Rev. 2020;2(2):CD000515.Google ScholarPubMed
Paraskevas, KI, Kalmykov, EL, Naylor, AR. Stroke/Death rates following carotid artery stenting and carotid endarterectomy in contemporary administrative dataset registries: a systematic review. Eur J Vasc Endovasc Surg. 2016;51(1):3–12.10.1016/j.ejvs.2015.07.032CrossRefGoogle ScholarPubMed
Bonati, LH, Kakkos, S, Berkefeld, J, de Borst, GJ, Bulbulia, R, Halliday, A, et al. European stroke organisation guideline on endarterectomy and stenting for carotid artery stenosis. Eur Stroke J. 2021;6(2):I–XLVII.10.1177/23969873211012121CrossRefGoogle ScholarPubMed
Yogendrakumar, V, Shamy, M, Dewar, B, Fergusson, DA, Dowlatshahi, D, Hamel, C, et al. Identifying sex-specific differences in the carotid revascularisation literature: findings from a scoping review. Stroke Vasc Neurol. 2021;6(3):496–499.10.1136/svn-2020-000744CrossRefGoogle ScholarPubMed
Rockman, C, Caso, V, Schneider, PA. Carotid interventions for women: the hazards and benefits. Stroke. 2022;53(2):611–623.10.1161/STROKEAHA.121.035386CrossRefGoogle ScholarPubMed
Howard, VJ, Algra, A, Howard, G, Bonati, LH, de Borst, GJ, Bulbulia, R, et al. Absence of consistent sex differences in outcomes from symptomatic carotid endarterectomy and stenting randomized trials. Stroke. 2021;52(2):416–423.10.1161/STROKEAHA.120.030184CrossRefGoogle ScholarPubMed