Abstract WMP94: Frequency And Outcome Of Endovascular Rescue After Carotid Endarterectomy: Analysis Of The National Inpatient Sample

Abstract

Introduction: Secondary thrombosis or embolism in the immediate period after carotid endarterectomy (CEA) may require urgent/emergent endovascular rescue (i.e., carotid artery stenting [CAS] and/or thrombectomy). We aimed to estimate the proportion such rescue procedures after CEA in a national setting, and to compare their outcomes to CEA patients not undergoing endovascular rescue. Methods: Using the 2018 National Inpatient Sample database and ICD-10 codes, all adult patients undergoing CEA were selected. Endovascular rescue was defined as CAS or thrombectomy performed on the same side as CEA, on the same day as or the days after CEA, and in the same hospitalization. Results: A total of 68005 patients undergoing CEA were studied (mean age±SD: 71.24±8.97, 39735 [58.4%] male). Of these, 310 (0.5%) patients underwent endovascular rescue (220 [71%] CAS, 60 [19.4%] thrombectomy, and 30 [9.7%] both). In 240 (77.4%) of these patients, rescue was performed the same day as CEA. Patients undergoing endovascular rescue were not different in age (p=0.21) or sex (p=0.06) but were different in race (p=0.02), income (p=0.002), and insurance (p<0.001) compared to patients without rescue (Table). Patients undergoing rescue had a longer length of hospital stay (5.6±5.1 vs 2.9±4.4 days, p<0.001), lower frequency of routine discharge (58.1% vs 82.4%, p<0.001), and higher mortality (4.8% vs 0.5%, p<0.001). Conclusions: Endovascular rescue is rarely needed in the immediate postoperative period after CEA but is associated with worse outcomes and higher mortality. A better understanding of factors associated with endovascular rescue may help better predict and prevent the need for such procedures.