London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 463 336 Vascular surgery and neurosurgery The risks of carotid endarterectomy (CEA) have declined: an analysis of two trials with simi-lar protocols F. Kennedy1, J. Dobson2, D. Doig3, R.L. Featherstone4, T. Richards5, M.M. Brown6 Institute of Neurology, University College London, London, UNITED KINGDOM1, Depart-ment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UNITED KINGDOM2, Institute of Neurology, University College London, London, UNITED KINGDOM3, Institute of Neurology, University College London, London, UNITED KINGDOM4, Institute of Neurology, University College London, London, UNITED KINGDOM5, Institute of Neurology, University College London, London, UNITED KINGDOM6 Background: We carried out two randomised clinical trials (CAVATAS and ICSS) comparing carotid endarterectomy (CEA) with endovascular therapy for symptomatic carotid artery stenosis using sim-ilar protocols. Risk factor control, surgical technique and care pathways have evolved. We hypoth-esised that these factors would result in a reduction in perioperative risk over the time course of the trials. Methods: We performed separate per protocol analysis of the rate of operative complications within 30 days of CEA within CAVATAS and then ICSS, and compared this by year of randomisation using logistic regression analysis. Results were adjusted for available baseline characteristics. Results: In CAVATAS, 246 patients had CEA. The 30-day risk of stroke or death after CEA fell from 15% in 1992-93 to 7.6% in 1996-1997, but the trend over time was not statistically significant (p=0.24). In ICSS, the 30-day risk fell significantly from 9.8% in 2001-2002 to 2.1% in 2007-2008 with an estimated 22% (95% CI 6% to 37%) annual reduction in the odds of 30-day stroke or death (p=0.018). Year of randomisation remained a significant variable after adjustment for baseline char-acteristics. There was no significant fall in the rate of cranial nerve palsy and severe haematoma over time (OR = 0.93, 95% CI 0.82, 1.06, p=0.26). There was an estimated reduction in mean base-line cholesterol level of 0.12mmol/L per 1 year increase in randomisation year (95% CI 0.07, 0.18, p=<0.001) but baseline cholesterol was not associated with 30-day risk in ICSS (odds ratio 0.97, 95% CI 0.72, 1.32, p=0.87). Conclusion: The risks of stroke or death, but not cranial nerve palsy or haematoma after CEA de-clined significantly from 2001 to 2008. Baseline cholesterol levels have also reduced significantly over the same time, but there is no evidence that this contributed to the reduction in CEA risk. Oth-er factors for which we cannot account because of unavailable data e.g. prior statin use, could have contributed. 337 Vascular surgery and neurosurgery Transcranial Doppler Derived Pulsitility Index is a Reliable Marker for Monitoring Intracra-nial Pressure B.R. Wakerley1, K. Yohanna2, A.K. Sharma3, K. Kumar4, H.L. Teoh5, V.K. Sharma6 National University Health System, Singapore, SINGAPORE1, National University Health Sys-tem, Singapore, SINGAPORE2, Shalby Hospital, Ahmedabd, INDIA3, Yashoda Hospital, Hyder-abad, INDIA4, National University Health System, Singapore, SINGAPORE5, National University of Singapore, Singapore, SINGAPORE6 Background and Aim-Transcranial Dopper (TCD) ultrasonography is a sensitive, non-invasive bed-side test, which is used to evaluate cerebral blood flow hemodynamics in the major arteries of the circle of Willis. TCD derived pulsatility index (PI), calculated as the difference in blood velocities measured during systole (Vs) and diastole (Vd), divided by the mean velocity (Vm) (Vd-Vs)/Vm, is believed to be influenced by intracranial pressure (ICP). We aimed to correlate TCD-PI with ce-rebrospinal fluid (CSF) pressure measurements acquired during standard lumbar puncture (LP) ma-nometry (representing ICP). Methods- Consecutive patients undergoing lumbar puncture for various diagnoses were included. Opening and closing CSF pressures (P-csf) were measured in all subjects. Stable TCD traces for 1-minute were obtained just before and after LP from both middle cerebral arteries (MCA) using a Spencer’s head frame and a traditional 2MHz transducer (Sonara TCD system, USA). Patients with insufficient temporal acoustic windows on TCD were excluded. Opening and closing PI values were calculated from the TCD spectra by an independent neurosonologist. Results- A total of 78 subjects (females = 30, male = 48; mean age 47years, range 20-82 years) were recruited. PI significantly decreased following LP (1.03 vs. 0.96, p=0.0001) in 53/78 (68%) of subjects and corresponded to 4.5±3.6cm CSF drop in P-csf. Patients with P-csf greater than 25cm had significantly higher PI (0.99 in cases with P-csf <25cm vs.1.16 in cases with P-csf >25cm; p=0.0009). Analysis of 156 matched P-csf and PI values revealed a weak correlation (r2=0.136, p<0.0001). However, when the age-adjusted PI showed a better relationship (r2=0.337, p<0.0001). Mean arterial blood pressure and pulse pressure had no effect on this relationship. Conclusion- Absolute PI values can be used to identify patients with extremely high ICP. Changes in serial age-adjusted PI values can be used to monitor changes in ICP.
Karger_ESC London_2013
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