Factors Determining Periprocedural and Long-term Complications of High Risk Carotid Artery Stenting
Vincent Dinculescu1, Anne C M Ritter2, Marlise P dos Santos3
11Faculty of Medicine.
Insights
Carotid artery stenting (CAS) is a safe option for high-risk patients, showing low periprocedural complications. Chronic kidney disease is a key risk factor for complications after CAS.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Carotid artery stenting (CAS) serves as an alternative to carotid endarterectomy (CEA) for stroke prevention.
- High-risk patients with carotid atherosclerosis often require intervention.
Purpose of the Study:
- To assess periprocedural and long-term stroke or death rates following CAS.
- To identify risk factors for complications in high-risk patients undergoing CAS.
Main Methods:
- Analysis of clinical and treatment variables from consecutive CAS procedures (2002-2011).
- Utilized univariate and multivariate logistic regression to evaluate patient characteristics' influence on outcomes and modified Rankin Score (mRS).
Main Results:
- A 3.95% composite rate of periprocedural death, stroke, TIA, and MI was observed in 152 patients.
- Chronic kidney disease (CKD) strongly correlated with periprocedural complications (p<0.001).
- CAD/PVD, dyslipidemia, CKD, and contralateral stenosis were linked to increased mRS; CAD/PVD and dyslipidemia predicted long-term complications.
Conclusions:
- CAS demonstrated low periprocedural complication rates in high-risk patients.
- These findings support CAS consideration for patients at high risk for CEA.
- CKD is identified as a significant factor for periprocedural risk stratification.
Background And Purpose:
Carotid artery stenting (CAS) has been, historically, an alternative to open endarterectomy (CEA) for stroke prevention in high risk patients with carotid atherosclerosis. We sought to determine the rates of periprocedural and long-term stroke or death and the risk factors for complications after CAS in our high risk patient population.
Methods:
Clinical and treatment variables of consecutive CAS procedures performed between 2002 and 2011 were analyzed. Using univariate and multivariate logistic regression analyses we examined how patient characteristics influenced outcomes and changes in modified Rankin Score (mRS).
Results:
In 152 patients, the composite total of periprocedural death, stroke, transient ischemic attack (TIA) and myocardial infarction (MI) rate was 3.95% (6/152). Chronic kidney disease (CKD) was strongly associated with periprocedural complications (p<0.001). Coronary artery disease/peripheral vascular disease (CAD/PVD) (p=0.03), dyslipidemia (p=0.02), CKD (p=0.01), and contralateral internal carotid artery stenosis (p=0.02) were non-modifiable risk factors for mRS increase. There were 25 deaths, 8 strokes, 11 TIAs, and 1 MI (mean follow-up 38.4 months, range 0-116 months). The presence of CAD/PVD (p=0.009) and dyslipidemia (p=0.002) were significantly associated with long-term complications.
Conclusion:
CAS was performed with low periprocedural complications in high-risk patients. Our rates compare very favorably to large-scale trials that have ideal patients. This data encourages the consideration of CAS in patients considered high risk for CEA and provides possible patient characteristics (CKD) to help with periprocedural risk stratification.
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