High-Risk Factors in Symptomatic Patients Undergoing Carotid Artery Stenting With Distal Protection: Buffalo Risk
Andrew A Fanous1, Sabareesh K Natarajan, Patrick K Jowdy
1Departments of *Neurosurgery, §§Neurology, and #Radiology, School of Medicine and Biomedical Sciences; ‖Department of Biostatistics, and **Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; ‡Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York; §Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona; ¶Department of Neurosurgery, University of South Florida, Tampa, Florida; ‡‡Jacobs Institute, Buffalo, New York.
Insights
Carotid artery stenting (CAS) complications can be predicted by patient demographics and vascular anatomy. A new CAS scoring system helps identify high-risk patients to potentially avoid the procedure.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Patient demographics and vascular anatomy are crucial for predicting complications during carotid artery stenting (CAS).
- Symptomatic patients undergoing CAS face risks that necessitate careful pre-procedural assessment.
Purpose of the Study:
- To identify factors predicting increased complication risk in symptomatic patients undergoing CAS.
- To develop a novel Carotid Artery Stenting (CAS) scoring system for risk prediction in this population.
Main Methods:
- A retrospective analysis of 221 patients undergoing CAS for symptomatic carotid stenosis over three years.
- Correlation of demographic and anatomical characteristics with 30-day periprocedural outcomes.
Main Results:
- Overall complication rate was 7.2%, including stroke (3.2%), myocardial infarction (3.2%), and death (1.4%).
- Risk factors identified include renal disease, high National Institutes of Health Stroke Scale score (≥10), difficult femoral access, specific aortic arch types, carotid artery calcification/tortuosity, and challenging anatomy for device deployment.
- Specific anatomical factors correlated with increased risk of stroke, myocardial infarction, or death.
Conclusions:
- CAS may be contraindicated in patients with multiple identified anatomic risk factors.
- High presenting National Institutes of Health Stroke Scale score and renal disease are significant predictors of complications.
- The developed CAS scoring system is a simple, reproducible tool for predicting periprocedural complications in symptomatic patients undergoing CAS.
Background:
Demographics and vascular anatomy may play an important role in predicting periprocedural complications in symptomatic patients undergoing carotid artery stenting (CAS).
Objective:
To predict factors associated with increased risk of complications in symptomatic patients undergoing CAS and to devise a CAS scoring system that predicts such complications in this patient population.
Methods:
A retrospective study was conducted that included patients who underwent CAS for symptomatic carotid stenosis during a 3-year period. Demographics and anatomic characteristics were subsequently correlated with 30-day outcome measures.
Results:
A total of 221 patients were included in the study. The cumulative rate of periprocedural complications was 7.2%, including stroke (3.2%), myocardial infarction (3.2%), and death (1.4%). Renal disease increased the risk of all complications. National Institutes of Health Stroke Scale score ≥10 at presentation, difficult femoral access, and diseased calcified aortic arch increased the risk of stroke and all complications. Type III aortic arch correlated with increased risk of stroke. Pseudo-occlusion and concentric calcification of the carotid artery increased the risk of myocardial infarction, death, and all complications. Carotid tortuosity and anatomy hostile to the deployment of distal protection devices increased the risk of stroke, myocardial infarction, death, and all complications.
Conclusion:
Our results suggest that CAS should be avoided in patients with multiple anatomic risk factors. High presenting National Institutes of Health Stroke Scale score and renal disease also increase the complication risk. The CAS scoring system devised here is simple, reproducible, and clinically valuable in predicting complications risk in symptomatic patients undergoing CAS.
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