Anatomical and technical predictors of perioperative clinical outcomes after carotid artery stenting
Ali F AbuRahma1, Trevor DerDerian1, Nizar Hariri1
1Department of Surgery, West Virginia University, Charleston, WVa.
Insights
Heavily calcified lesions and percutaneous transluminal angioplasty (PTA) before embolic protection device (EPD) insertion increase stroke risk during carotid artery stenting (CAS). The ACCUNET EPD showed lower major adverse event rates.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Neurology
Background:
- Carotid artery stenting (CAS) is a procedure to open blocked carotid arteries.
- Anatomical and technical factors can influence CAS outcomes.
- Previous studies have explored these influences, but further analysis is warranted.
Purpose of the Study:
- To investigate the impact of anatomical and technical factors on perioperative stroke, myocardial infarction, and death after CAS.
- To identify specific risk factors associated with adverse events during CAS.
Main Methods:
- Retrospective analysis of prospectively collected data from 409 patients undergoing CAS.
- Logistic regression analysis to determine the effects of anatomical and technical factors on major adverse events (MAEs).
- Comparison of outcomes based on lesion characteristics, prior interventions, and embolic protection devices (EPDs).
Main Results:
- The overall MAE rate was 4.7%, with a stroke rate of 2.2%.
- Heavily calcified lesions (6.3% stroke rate) and percutaneous transluminal angioplasty (PTA) before EPD insertion (9.1% stroke rate) were associated with higher stroke rates.
- The ACCUNET EPD was associated with significantly lower MAE rates (1.9%) compared to other EPDs (6.7%).
Conclusions:
- Calcific lesions and PTA before EPD insertion are significant risk factors for stroke and MAEs after CAS.
- The ACCUNET EPD demonstrates a favorable safety profile, associated with reduced MAE rates.
- No significant correlation was found between other anatomical or technical variables and CAS outcomes.
Background:
A few other studies have reported the effects of anatomical and technical factors on clinical outcomes of carotid artery stenting (CAS). This study analyzed the effect of these factors on perioperative stroke/myocardial infarction/death after CAS.
Methods:
This was a retrospective analysis of prospectively collected data of 409 of 456 patients who underwent CAS during the study period. A logistic regression analysis was used to determine the effects of anatomical and technical factors on perioperative stroke, death, and myocardial infarction (major adverse events [MAEs]).
Results:
The MAE rate for the entire series was 4.7% (19 of 409), and the stroke rate was 2.2% (9 of 409). The stroke rate for asymptomatic patients was 0.46% (1 of 218; P = .01). The MAE rates for patients with transient ischemic attack (TIA) were 7% (11 of 158) vs 3.2% (8 of 251) for other indications (P = .077). The stroke rates for heavily calcified lesions were 6.3% (3 of 48) vs 1.2% (4 of 332) for mildly calcified/noncalcified lesions (P = .046). Differences in stroke and MAE rates regarding other anatomical features were not significant. The stroke rate for patients with percutaneous transluminal angioplasty (PTA) before embolic protection device (EPD) insertion was 9.1% (2 of 22) vs 1.8% (7 of 387) for patients without (P = .07) and 2.6% (9 of 341) for patients with poststenting PTA vs 0% (0 of 68) for patients without. The MAE rate for patients with poststenting PTA was 5.6% (19 of 341) vs 0% (0 of 68) for patients without (P = .0536). The MAE rate for patients with the ACCUNET (Abbott, Abbott Park, Ill) EPD was 1.9% (3 of 158) vs 6.7% (16 of 240) for others (P = .029). The differences between stroke and MAE rates for other technical features were not significant. A regression analysis showed that the odds ratio for stroke was 0.1 (P = .031) for asymptomatic indications, 13.7 (P = .014) for TIA indications, 6.1 (P = .0303) for PTA performed before EPD insertion, 1.7 for PTA performed before stenting, and 5.4 (P = .0315) for heavily calcified lesions. The MAE odds ratio was 0.46 (P = .0858) for asymptomatic indications, 2.1 for PTAs performed before EPD insertion, 2.2 for poststent PTAs, and 2.2 (P = .1888) for heavily calcified lesions. A multivariate analysis showed that patients with TIA had an odds ratio of stroke of 11.05 (P = .029). Patients with PTAs performed before EPD insertion had an OR of 6.15 (P = .062). Patients with heavily calcified lesions had an odds ratio of stroke of 4.25 (P = .0871). The MAE odds ratio for ACCUNET vs others was 0.27 (P = .0389).
Conclusions:
Calcific lesions and PTA before EPD insertion or after stenting were associated with higher stroke or MAE rates, or both. The ACCUNET EPD was associated with lower MAE rates. There was no correlation between other anatomical/technical variables and CAS outcome.
