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COMPARISON OF SHORT-TERM CLINICAL OUTCOMES BETWEEN PATIENTS WITH SYMPTOMATIC EXTRACRANIAL CAROTID OR INTRACRANIAL ATHEROSCLEROTIC DISEASE
COMPARISON OF SHORT-TERM CLINICAL OUTCOMES BETWEEN PATIENTS WITH SYMPTOMATIC EXTRACRANIAL CAROTID OR INTRACRANIAL ATHEROSCLEROTIC DISEASE
Abstract
Background and Aims
Existing studies that directly compared the outcomes of patients with intracranial atherosclerotic disease (ICAD) and extracranial carotid atherosclerotic disease (ECAD) compared only long-term outcomes, with no attention paid to short-term outcomes. Therefore, we aimed to directly compare the 90-day outcomes of patients with ICAD, ECAD, and concurrent ICAD and ECAD (ICAD + ECAD).
Methods
Patients with symptomatic ICAD and/or ECAD were prospectively enrolled between 2016 and 2021. The 90-day outcomes analyzed were death, myocardial infarction (MI), ischemic stroke, and major adverse cardiovascular events (MACE; death, MI, and/or ischemic stroke).
Results
Of 371 patients included in the analysis, 240 (64.7%) patients had ICAD only, 93 (25.0%) patients had ECAD only, and 38 (10.3%) patients had ICAD + ECAD. On multivariate analysis with ICAD as the reference comparator, the risk of 90-day clinical outcomes was highest among patients with ICAD + ECAD, with adjusted hazard ratios of 9.32 (95% CI=1.58, 54.8; p=0.014), 4.54 (95% CI=1.45, 14.2; p=0.006), and 8.52 (95% CI=3.54, 20.5; p<0.001) for 90-day MI, ischemic stroke, and MACE respectively. Among patients with ECAD only, the risks of 90-day MI, ischemic stroke, and MACE were similar, with adjusted hazard ratios of 9.91 (95% CI=2.10, 46.7; p=0.004), 3.98 (95% CI=1.48, 10.7; p=0.006), and 8.09 (95% CI=3.87, 16.9; p<0.001) respectively.
Conclusions
Patients with ICAD + ECAD and ECAD only have a significantly higher risk of 90-day MI, ischemic stroke, and MACE. These patients may benefit from further evaluation of the coronary arteries and more aggressive medical therapy to reduce the risk of ischemic events.