Abstract Details

Title Elective Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) - Comparison of Autonomic Outcome after Elective Carotid Revascularization

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 169

Objective

Background BACKGROUND: Validation of carotid revascularization focuses on stroke prevention. CEA and CAS do not evidently differ in the prevention of stroke in patients with asymptomatic extracranial internal carotid stenosis (Bonati, 2012). Carotid stenosis interferes with carotid baro- and chemoreceptor function and results in autonomic dysfunction (Doux, 2005). Autonomic dysfunction strongly predicts cardio- and cerebrovascular morbidity and mortality (Binici, 2011; Tsuji, 1996). Autonomic function after elective carotid revascularization has never been systematically examined.

Design/Methods DESIGN/METHODS: Examination of autonomic function (HRV, CRS, BRS) in 42 patients with >=70% asymptomatic extracranial carotid stenosis prior and four weeks after elective carotid revascularization (CEA n=24, CAS n=18).

Results RESULTS: In patients with CEA compared to patients with CAS, post-interventional total HRV was higher (p<0.009) indicating improved global autonomic function and CRS was lower (p<0.014) indicating improved chemoreceptor function. Post-interventional HRV and CRS also depended on pre-interventional autonomic state (total HRV p<0.002; CRS p<0.001). Patients with bilateral stenosis showed lower total HRV (p<0.059) and higher CRS (p<0.016) indicating decreased post-interventional global autonomic function and chemoreceptor function compared to patients with unilateral stenosis. Post-interventional total HRV but not CRS tended to be associated with age (p<0.092). Post-interventional BRS was neither determined by intervention nor by pre- interventional BRS, presence of bilateral stenosis and age.

Conclusions CONCLUSIONS: Improvement of autonomic function is superior after CEA compared to CAS. Further determinants of post-interventional autonomic function are pre-interventional autonomic state and presence of bilateral stenosis. Improvement of autonomic function after CEA is primarily based on restoration of chemoreceptor but not on baroreceptor function and is potentially beneficial for cardio- and cerebrovascular long-term outcome.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Matthias Schwab, PhD (Klinik f.Neurol.u.Psychiatrie)	No disclosure on file
Gary R. Cutter, PhD (University of Alabama At Birmingham)	Dr. Cutter has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for onsulting or Advisory Boards: Alexion, Antisense Therapeutics/Percheron, Avotres, Biogen, Clene Nanomedicine, Clinical Trial Solutions LLC, Endra Life Sciences, Cognito Therapeutics, Genzyme, Genentech, Immunic, Klein-Buendel Incorporated, Kyverna Therapeutics, Inc. , Linical, Merck/Serono, Noema, Neurogenesis, Perception Neurosciences, Protalix Biotherapeutics, Regeneron, Revelstone Consulting, Roche, SAB Biotherapeutics, Sapience Therapeutics, Scott&Scott LLP, Tenmile.. Dr. Cutter has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Data and Safety Monitoring Boards: Applied Therapeutics, AI therapeutics, AMO Pharma, Argenx, Astra-Zeneca, Avexis Pharmaceuticals, Bristol Meyers Squibb, CSL Behring, Cynata Therapeutics, DiamedicaTherapeutics, Horizon Pharmaceuticals, Immunic, Inhibrix, Karuna Therapeutics, Kezar Life Sciences, Medtronic, Merck, Meiji Seika Pharma, Mitsubishi Tanabe Pharma Holdings, Prothena Biosciences, Novartis, Pipeline Therapeutics (Contineum), Regeneron, Sanofi-Aventis, Teva Pharmaceuticals, United BioSource LLC, University of Texas Southwestern.. Dr. Cutter has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JASN.

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