Mediators of the Age Effect in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

Stroke; a Journal of Cerebral Circulation
Jenifer H VoeksThomas G Brott

Abstract

There is higher combined risk of stroke or death (S+D) at older ages with carotid stenting. We assess whether this can be attributed to patient or arterial characteristics that are in the pathway between older age and higher risk. Mediation analysis of selected patient (hypertension, diabetes mellitus, and dyslipidemia) and arterial characteristics assessed at the clinical sites and the core laboratory (plaque length, eccentric plaque, ulcerated plaque, percent stenosis, peak systolic velocity, and location) was performed in 1123 carotid artery stenting-treated patients in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). We assessed the association of age with these characteristics, the association of these characteristics with stroke risk, and the amount of mediation of the association of age on the combined risk of periprocedural S+D with adjustment for these factors. Only plaque length as measured at the sites increased with age, was associated with increased S+D risk and significantly mediated the association of age on S+D risk. However, adjustment for plaque length attenuated the increased risk per 10 years of age from 1.72 (95% confidence interval, 1.26-2.37) to 1.66 (95% confidence interval, 1....Continue Reading

References

May 1, 2007·Journal of Vascular Surgery·Russell C LamPeter L Faries
Aug 30, 2008·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Paul T L ChiamJiri J Vitek
Jan 22, 2010·International Journal of Stroke : Official Journal of the International Stroke Society·A J SheffetT G Brott
Jan 1, 1995·Multivariate Behavioral Research·David P MackinnonJames H Dwyer
May 28, 2010·The New England Journal of Medicine·Thomas G BrottUNKNOWN CREST Investigators
Jan 29, 2011·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·L H BonatiUNKNOWN Carotid Stenting Trialists' Collaboration
Oct 8, 2011·Stroke; a Journal of Cerebral Circulation·Jenifer H VoeksUNKNOWN CREST Investigators
Jul 31, 2013·International Journal of Stroke : Official Journal of the International Stroke Society·Leo H BonatiUNKNOWN CAVATAS Investigators

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Citations

Mar 15, 2016·Current Treatment Options in Cardiovascular Medicine·Josephine F Huang, James F Meschia
Nov 21, 2015·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Gianmarco de DonatoBernhard Reimers
Jan 27, 2018·Stroke; a Journal of Cerebral Circulation·Richard I Lindley
Dec 22, 2016·Current Opinion in Neurology·David CalvetUNKNOWN Carotid Stenosis Trialists’ Collaboration
Apr 1, 2020·Continuum : Lifelong Learning in Neurology·Michael F Waters
Aug 21, 2020·Clinical Trials : Journal of the Society for Clinical Trials·Linda SharplesSabine Landau
Jan 26, 2021·Stroke; a Journal of Cerebral Circulation·Virginia J HowardUNKNOWN Carotid Stenosis Trialists’ Collaboration
Jun 7, 2020·Annals of Vascular Surgery·Susanna W L de GeusJeffrey J Siracuse
Apr 23, 2021·Journal of Vascular Surgery·Muhammad FaatehMahmoud Malas
Apr 24, 2019·Journal of Vascular Surgery·Besma NejimMahmoud B Malas
Sep 8, 2019·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·Andrew J BatchelderA Ross Naylor

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