Carotid artery stenting: identification of risk factors for poor outcomes
Benjamin M Jackson1, Sean J English, Ronald M Fairman
1Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. benjamin.jackson@uphs.upenn.edu
Insights
Chronic renal insufficiency, obesity, and emergency admission are key risk factors for complications during carotid artery angioplasty and stenting (CAS). Age over 80 did not significantly increase complication or stroke rates in this study.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Nephrology
Background:
- Carotid artery angioplasty and stenting (CAS) is a procedure to treat carotid artery stenosis.
- Advanced age (over 80) is a known risk factor for CAS complications.
- Other predictors of perioperative complications require further investigation.
Purpose of the Study:
- To identify predictors of perioperative complications in patients undergoing CAS.
- To evaluate the association between comorbidities, admission status, and CAS outcomes.
Main Methods:
- Retrospective analysis of 215 CAS procedures in 198 patients (July 2003 - December 2005).
- Analysis of patient age, comorbidities (including renal function and obesity), and admission status as predictor variables.
- Logistic regression and statistical tests used to determine outcome variables (complications, stroke, length of stay, discharge disposition).
Main Results:
- Chronic renal insufficiency (serum creatinine > 1.3 mg/dL) significantly increased complication (37% vs 13%) and stroke (11.1% vs 0.6%) rates.
- Obesity was a risk factor for complications (28% vs 16%), but not stroke.
- Emergency admission predicted longer hospital stays and need for post-discharge care.
- No significant difference in complication or stroke rates was found for patients over 80.
Conclusions:
- Chronic renal insufficiency, obesity, and emergent clinical settings are significant risk factors for CAS.
- These findings can help refine patient selection and risk stratification for CAS procedures.
Objectives:
Age greater than 80 has been identified as a risk factor for complications, including stroke and death, in patients undergoing carotid artery angioplasty and stenting (CAS). This study evaluates other potential predictors of perioperative complications in patients undergoing CAS.
Methods:
All cerebrovascular endovascular procedures performed by the vascular surgery division at our university hospital between July 2003 and December 2005 were retrospectively examined. During the course of 212 admissions, 198 patients underwent 215 procedures. Patient age, comorbidities, and admission status were analyzed as independent (predictor) variables. Complication rate, discharge disposition, and length of hospital stay were considered dependent (outcome) variables. Logistic regression and Fisher exact test or Student t test were performed, as appropriate.
Results:
Complications included major and minor stroke, myocardial infarction, femoral artery pseudoaneurysm, and death. The rates of perioperative major and minor stroke were 0.5% and 2.8%, respectively. Chronic renal insufficiency was a predictor of perioperative complications, including stroke: patients with serum creatinine greater than 1.3 mg/dL had a 37% complication rate and a 11.1% stroke rate, while those with normal renal function had a 13% complication rate (P = .003) and a 0.6% stroke rate (P =.001). Similar association was seen between creatinine clearance and both stroke and complications. Obesity was a risk factor for complications, but not stroke: obese patients had a complication rate of 28%, while others had a 16% complication rate (P = .024). Emergency admission predicted both extended hospital stay (P < .001) and requirement for further inpatient care in a rehabilitation or nursing facility (P = .007). There was no significant difference in complication rate or stroke rate between octogenarians and others.
Conclusion:
This experience demonstrates that chronic renal insufficiency, obesity, and emergent clinical setting are risk factors for patients undergoing CAS.
