Comparison of carotid endarterectomy and stenting in real world practice using a regional quality improvement registry

OBJECTIVE: Carotid artery stenting (CAS) vs endarterectomy (CEA) remains controversial and has been the topic of recent randomized controlled trials. The purpose of this study was to compare the practice and outcomes of CAS and CEA in a real world setting. METHODS: This is a retrospective analysis of 7649 CEA and 430 CAS performed at 17 centers from 2003 to 2010 within the Vascular Study Group of New England (VSGNE). The primary outcome measures were (1) any in-hospital stroke or death and (2) any stroke, death, or myocardial infarction (MI). Patients undergoing CEA in conjunction with cardiac surgery were excluded. Multivariate logistic regression was performed to identify predictors of stroke or death in patients undergoing CAS. RESULTS: CEA was performed in 17 centers by 111 surgeons, while CAS was performed in 6 centers by 30 surgeons and 8 interventionalists. Patient characteristics varied by procedure. Patients undergoing CAS had a higher prevalence of coronary artery disease, congestive heart failure, diabetes, and prior ipsilateral CEA. Embolic protection was used in 97% of CAS. Shunts were used in 48% and patches in 86% of CEA. The overall in-hospital stroke or death rate was higher among patients undergoing CAS (2.3% vs 1.1%; P = .03). Overall stroke, death, or MI (2.8% CAS vs 2.1% CEA; P = .32) were not different. Asymptomatic patients had similar rates of stroke or death (CAS 0.73% vs CEA 0.89%; P = .78) and stroke, death, or MI (CAS 1.1% vs CEA 1.8%; P = .40). Symptomatic patients undergoing CAS had higher rates of stroke or death (5.1% vs 1.6%; P = .001), and stroke, death, or MI (5.8% vs 2.7%; P = .02). By multivariate analysis, major stroke (odds ratio, 4.5; 95% confidence interval [CI], 1.9-10.8), minor stroke (2.7; CI, 1.5-4.8), prior ipsilateral CEA (3.2, CI, 1.7-6.1), age \u3e80 (2.1; CI, 1.3-3.4), hypertension (2.6; CI, 1.0-6.3), and a history of chronic obstructive pulmonary disease (1.6; CI, 1.0-2.4) were predictors of stroke or death in patients undergoing carotid revascularization. CONCLUSIONS: In our regional vascular surgical practices, the overall outcomes of CAS and CEA are similar for asymptomatic patients. However, symptomatic patients treated with CAS are at a higher risk for stroke or death. rights reserved

Adult daughters' family structure and the association between reciprocity and relationship quality

The study explores whether family structure is a moderator of the associations between help exchange, reciprocity of this exchange, and the quality of the mother and adult daughter relationship. A total of 183 daughters (mean age = 42.13; SD = 4.91) are either in first marriage (n = 87), living with a new partner after divorce (n = 77), or unmarried or divorced in a single-parent household (n = 99). The analyses are based on the daughters` self-reports. Results show that intimacy in a relationship is more strongly associated with help exchange for daughters in first marriage than for both groups of divorced daughters. Among daughters who perceive that they give more help than they receive, only the single daughters report more conflict. Findings point to a higher importance of balance in support for single daughters