Carotid Artery Operation Delay During the Covid-19 Pandemic: Results of a Multicenter International Study.

Humans Carotid Stenosis / diagnostic imaging Pandemics Treatment Outcome COVID-19 Ischemic Attack, Transient Endarterectomy, Carotid / adverse effects Stroke / epidemiology Carotid Arteries

Journal

Annals of vascular surgery

ISSN: 1615-5947

Titre abrégé: Ann Vasc Surg

Pays: Netherlands

ID NLM: 8703941

Informations de publication

Date de publication:
Oct 2023

Historique:

received: 04 01 2023

revised: 09 04 2023

accepted: 14 05 2023

medline: 25 9 2023

pubmed: 25 6 2023

entrez: 24 6 2023

Statut: ppublish

Résumé

To measure the impact of the COVID-19 pandemic on the management of patients with carotid artery stenosis. We prospectively collected data from 25 centers (19 centers in the United States and 6 centers internationally) on postponed carotid artery operations between March 2020 and January 2022. We describe the characteristics of these patients and their planned operations, along with outcomes including mortality and neurological deterioration during the period of operative delay due to the COVID-19 pandemic. A total of 1,220 vascular operations were postponed during the pandemic, of them 96 patients presented with significant carotid stenosis (median stenosis of 71%; interquartile range; 70-80) and 80% of them were planned for carotid endarterectomy. Most patients were asymptomatic (69%), and 31% of patients were symptomatic (16% of patients had a stroke, 15% of patients had a transient ischemic attack, and 1% of patients experienced amaurosis fugax). The median length of surgical delay was 71 days (interquartile range: 45.5, 115.5). At the data entry time, 62% of patients had their carotid operations postponed and successfully completed. Most postponements (72%) were due to institutional policies aimed at resource conservation. During the delay, no patient decompensated or required an urgent operation. A total of 5 patients (5%) with carotid stenosis died while awaiting operations due to COVID-19. Our study of a cohort of patients with carotid artery stenosis who underwent a median delay of 71 days during the COVID-19 pandemic showed a disparate operation delay between US regions and internationally, most postponements were due to hospital policy, and none of the patients deteriorated or required an emergency surgery during the delay.

Sections du résumé

BACKGROUND BACKGROUND

To measure the impact of the COVID-19 pandemic on the management of patients with carotid artery stenosis.

METHODS METHODS

We prospectively collected data from 25 centers (19 centers in the United States and 6 centers internationally) on postponed carotid artery operations between March 2020 and January 2022. We describe the characteristics of these patients and their planned operations, along with outcomes including mortality and neurological deterioration during the period of operative delay due to the COVID-19 pandemic.

RESULTS RESULTS

A total of 1,220 vascular operations were postponed during the pandemic, of them 96 patients presented with significant carotid stenosis (median stenosis of 71%; interquartile range; 70-80) and 80% of them were planned for carotid endarterectomy. Most patients were asymptomatic (69%), and 31% of patients were symptomatic (16% of patients had a stroke, 15% of patients had a transient ischemic attack, and 1% of patients experienced amaurosis fugax). The median length of surgical delay was 71 days (interquartile range: 45.5, 115.5). At the data entry time, 62% of patients had their carotid operations postponed and successfully completed. Most postponements (72%) were due to institutional policies aimed at resource conservation. During the delay, no patient decompensated or required an urgent operation. A total of 5 patients (5%) with carotid stenosis died while awaiting operations due to COVID-19.

CONCLUSIONS CONCLUSIONS

Our study of a cohort of patients with carotid artery stenosis who underwent a median delay of 71 days during the COVID-19 pandemic showed a disparate operation delay between US regions and internationally, most postponements were due to hospital policy, and none of the patients deteriorated or required an emergency surgery during the delay.

Identifiants

DOI: 10.1016/j.avsg.2023.05.041 PMID: 37355018

pubmed: 37355018

pii: S0890-5096(23)00324-2

doi: 10.1016/j.avsg.2023.05.041

pii:

doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

44-56

Investigateurs

Mahmood Kabeil (M)

Max V Wohlauer (MV)

Mario D'Oria (M)

Vipul Khetarpaul (V)

Riley Gillette (R)

Ethan Moore (E)

Kathryn Colborn (K)

Robert F Cuff (RF)

Leigh Ann O'Banion (LA)

Amna Ali (A)

Leah Lucero (L)

Michael Costanza (M)

Eric Hammond (E)

Raghunandan L Motaganahalli (RL)

Humraaz Samra (H)

Gregory G Westin (GG)

Kara Allen (K)

Ulka Sachdev (U)

Elizabeth A Andraska (EA)

Mel Sharafuddin (M)

Judith Pena-Quevedo (J)

Issam Koleilat (I)

Matthew Carnevale (M)

Paola Batarseh (P)

Britt H Tonnessen (BH)

Nikolai Harroun (N)

Agnese Sataviciute (A)

Faisal Aziz (F)

Giovanni Tinelli (G)

Jason Chuen (J)

Jonathan Bath (J)

Joseph L Mills (JL)

Rana O Afifi (RO)

Raphaël Coscas (R)

Sherene Shalhub (S)

Reggie Nkansah (R)

Adam W Beck (AW)

Rebecca St John (R)

Fatemeh Malekpour (F)

Michael Siah (M)

Sooyeon Kim (S)

Mark G Davies (MG)

Grace Ihsiu Todd (GI)

Courtney Busby (C)

Peter R Nelson (PR)

Sydney Wyatt (S)

Sana Ahmed (S)

Ashley Cosentino (A)

Ahana Ghosh (A)

Jorge A Miranda (JA)

Inez Torres (I)

Ildar Fakhradiyev (I)

Albert Kota (A)

Santiago Mier Y Teran-Ellis (S)

Gabriel Lopez (G)

Carlos A Hinojosa (CA)

Nalaka Gunawansa (N)

Nicolas J Mouawad (NJ)

Kuldeep Singh (K)