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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Long-term mortality and follow-up after carotid artery stenting
S Arif1, J Wojtasik1, A Dziewierz1
12 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.
Insights
Carotid artery stenting (CAS) shows lower mortality than previously reported, with age and diabetes mellitus identified as key predictors of death. Further research is recommended to explore these associations.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Interventional Cardiology
Background:
- Carotid artery stenting (CAS) is a stroke prevention alternative to carotid endarterectomy.
- High comorbidity burden in CAS patients, including coronary and peripheral artery disease, impacts long-term outcomes.
- Limited data exists on very long-term mortality (over four years) and its predictors after CAS.
Purpose of the Study:
- To investigate very long-term survival rates following CAS.
- To determine the impact of comorbidities on mortality after CAS.
- To identify independent predictors of death in patients undergoing CAS.
Main Methods:
- Analysis of data from 194 patients who underwent CAS with cerebral protection systems (December 2002 - March 2014).
- Assessment of all-cause mortality during long-term follow-up.
- Application of univariate and multivariate Cox regression analysis to identify predictors of death.
Main Results:
- The median follow-up was 7.6 years, with an all-cause mortality rate of 31.4% at maximum follow-up.
- Cardio-cerebral vascular events accounted for 60% of deaths; cancer was the main cause of non-cardiac deaths (9/15).
- Age and diabetes mellitus were identified as independent predictors of all-cause death.
Conclusions:
- Mortality rates after CAS were lower than previously reported in the literature.
- Age and diabetes mellitus are significant independent predictors of long-term all-cause mortality post-CAS.
- Further research is warranted to confirm the association between these risk factors and decreased survival.
Background:
Carotid artery stenting (CAS) is an alternative to carotid endarterectomy for the prevention of stroke and transient ischemic attack (TIA). The high long-term mortality among patients who underwent CAS seems to be related to the high comorbidity burden, including coronary and peripheral artery disease. However, limited data on very long-term mortality (over four years) and predictors of death are available.
Aim:
We sought to investigate the very long-term survival after CAS and the impact of comorbidities on mortality at follow-up.
Methods:
Data of 194 symptomatic and asymptomatic patients who underwent CAS with cerebral protection systems from December 2002 to March 2014 were analyzed. All cause mortality during long-term follow-up was assessed. Univariate and multivariate Cox regression analysis was used to find independent predictors of death.
Results:
The median age of patients was 66 [interquartile range (IQR): 60-73] years and 78.9 % of patients were male. The median follow-up was 7.6 (IQR: 4.4-10.2) years. The all-cause mortality rate after 30 days, one year, four years, and at maximum follow-up was 0 %, 5.1 %, 17.5 % and 31.4 %, respectively. Out of 61 deaths, 37 (60 %) were cardio-cerebral vascular related deaths, 15 (25 %) non-cardiovascular deaths, and 9 (15 %) due to unknown reasons. Among cardio-cerebral vascular deaths, there were 12 fatal strokes, 18 fatal myocardial infarctions and seven other cardiac related deaths. Non-cardiac deaths were due mainly to cancer (9/15). Age and diabetes mellitus were independent predictors of all-cause death during long-term follow-up.
Conclusions:
The mortality rate during short and long-term follow-up after CAS was lower than reported in the literature. Age and diabetes mellitus were independent predictors of all-cause death. Further research is needed to confirm the potential association between those risk factors and decreased survival. Hippokratia 2016, 20(3): 204-208.
