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ABSTRACT: The majority (>80%) of the three-quarters of a million strokes that will occur in the United States this year are ischemic in nature. The treatment of acute ischemic stroke is very similar to acute myocardial infarction, which requires timely reperfusion therapy for optimal results. The majority of patients with acute ischemic stroke do not receive any form of reperfusion therapy, unlike patients with acute myocardial infarction. Improving outcomes for acute stroke will require patient education to encourage early presentation, an aggressive expansion of qualified hospitals, and willing providers and early imaging strategies to match patients with their best options for reperfusion therapy to minimize complications.
Journal of the American College of Cardiology 07/2011; 58(2):101-16. · 14.16 Impact Factor
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H Vernon Anderson,
Kenneth A Rosenfield,
Christopher J White,
Kalon K L Ho,
John A Spertus,
Philip G Jones,
Fengming Tang, Christopher U Cates,
Michael R Jaff,
Walter J Koroshetz,
Irene L Katzan,
L Nelson Hopkins,
John S Rumsfeld,
Ralph G Brindis
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ABSTRACT: In 2007, a multispecialty society task force published a clinical expert consensus document (CECD) on carotid stenting (CAS), containing recommendations for appropriate patient selection and quality of care. The CECD also inspired creation of a large, national registry of carotid revascularization, the Carotid Artery Revascularization and Endarterectomy (CARE) registry. Our goal here was to investigate whether initial CAS procedures submitted to CARE conformed to CECD recommendations, and examine their clinical outcomes.
We analyzed CAS procedures for the period January 1, 2005 through December 31, 2008. These were grouped into those that conformed to CECD recommendations [CECD(+), n = 4,636, 79.8%] and those that did not [CECD(-), n = 1,168, 20.2%].
The CECD(+) patients were older than CECD(-) patients (71.5 +/- 10.3 vs. 67.6 +/- 10.3 years, P = 0.001, respectively), and more frequently had chronic kidney disease (46.9% vs. 17.8%, P = 0.001), chronic lung disease (33.0% vs. 12.4%, P = 0.001), ejection fraction <or= 0.30 (13.5% vs. 5.5%, P = 0.001) and contralateral carotid artery occlusion (12.7% vs. 4.6%, P = 0.001). Clinical outcomes at 30 days were similar, including death (1.24% vs. 0.76%, P = 0.184), stroke (5.32% vs. 5.34%, P = 0.954), and death, stroke, or MI (7.04% vs. 6.95%, P = 0.944).
Most CAS procedures submitted to CARE conformed to CECD recommendations for patient selection. For reported data, clinical outcomes at 30 days were similar for procedures meeting and those not meeting recommendations, and were similar to outcomes reported by other large registries. These findings suggest that acceptable patient selection criteria for CAS are employed as it expands beyond investigators into more widespread clinical practice.
Catheterization and Cardiovascular Interventions 03/2010; 75(4):519-25. · 2.29 Impact Factor
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ABSTRACT: This is the first comprehensive national registry that will provide data characterizing contemporary results of carotid endarterectomy (CEA) and carotid artery stenting (CAS). Carotid endarterectomy (CEA) has become the standard revascularization therapy to prevent stroke in patients with carotid artery disease, while carotid artery stenting (CAS) offers a percutaneous alternative in selected patients. Given the rapid growth in the numbers of CAS procedures being performed, there is a critical need for a national program to assess quality outcomes. The Carotid Artery Revascularization and Endarterectomy (CARE) Registry was developed through a multispecialty collaboration resulting in a comprehensive data collection tool for carotid revascularization procedures. The intent of the CARE registry is to collect and analyze clinical data to measure clinical practice, patient outcomes, and enable quality improvement for carotid revascularization. Finally, the CARE Registry satisfies the Center for Medicare and Medicaid Services (CMS) data reporting criteria for reimbursement.
Catheterization and Cardiovascular Interventions 06/2008; 71(6):721-5. · 2.29 Impact Factor
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ABSTRACT: The primary therapeutic strategy for ischemic stroke, as for MI patients, is early reperfusion. Improvement in stroke treatment will require dedicated stroke centers to emulate MI quality indicators such as minimizing the "door-to-balloon time". A critical element in achieving this goal will be organizing the existing multidisciplinary pool of carotid interventionalists to provide the endovascular component of the acute care for ischemic stroke patients.
Catheterization and Cardiovascular Interventions 10/2007; 70(3):471-6. · 2.29 Impact Factor
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Eric R Bates,
Joseph D Babb,
Donald E Casey, Christopher U Cates,
Gary R Duckwiler,
Ted E Feldman,
William A Gray,
Kenneth Ouriel,
Eric D Peterson,
Kenneth Rosenfield,
John H Rundback,
Robert D Safian,
Michael A Sloan,
Christopher J White
Vascular Medicine 03/2007; 12(1):35-83. · 1.46 Impact Factor
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Eric R Bates,
Joseph D Babb,
Donald E Casey, Christopher U Cates,
Gary R Duckwiler,
Ted E Feldman,
William A Gray,
Kenneth Ouriel,
Eric D Peterson,
Kenneth Rosenfield,
John H Rundback,
Robert D Safian,
Michael A Sloan,
Christopher J White
Journal of the American College of Cardiology 02/2007; 49(1):126-70. · 14.16 Impact Factor
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Kenneth Rosenfield,
Joseph D Babb, Christopher U Cates,
Michael J Cowley,
Ted Feldman,
Anthony Gallagher,
William Gray,
Richard Green,
Michael R Jaff,
K Craig Kent,
Kenneth Ouriel,
Gary S Roubin,
Bonnie H Weiner,
Christopher J White
Journal of the American College of Cardiology 02/2005; 45(1):165-74. · 14.16 Impact Factor
