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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 After Carotid Stenting
Lorenzo Rinaldo1, Adip G Bhargav2, Catherine E Arnold Fiebelkorn3
1Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Carotid artery stenting (CAS) offers acceptable long-term survival in appropriately selected patients, contrasting with some population studies. Key mortality risks include older age and heart failure.
Area of Science:
- Vascular Surgery
- Interventional Neurology
- Cardiovascular Medicine
Background:
- Carotid artery stenting (CAS) treats extracranial internal carotid artery atherosclerotic disease.
- Population studies question long-term efficacy of CAS.
- Real-world data is needed to assess CAS outcomes.
Purpose of the Study:
- To evaluate long-term outcomes of CAS.
- To identify risk factors for mortality after CAS.
- To assess CAS efficacy in a real-world setting.
Main Methods:
- Retrospective review of 238 patients undergoing CAS (2008-2018).
- Data collected on patient/disease characteristics, ischemia, and mortality.
- Cox proportional hazards model used for risk factor analysis.
Main Results:
- Mean age 69.7 years, 69.7% male; 62.2% for symptomatic stenosis.
- 14 patients (5.9%) had ischemia; 8 (3.4%) had stroke with permanent deficit.
- 59 patients (24.8%) died; age and congestive heart failure were independent mortality risk factors.
Conclusions:
- CAS demonstrates acceptable long-term survival in adequately selected patients.
- Findings contrast with some population-based studies.
- Supports judicious use of CAS for appropriate indications.
Background:
Carotid artery stenting (CAS) is an established procedure for the treatment of atherosclerotic disease affecting the extracranial internal carotid artery. Recent population-based studies have suggested that long-term survival after CAS may be limited, thereby questioning its efficacy in a real-world scenario.
Methods:
We retrospectively reviewed outcomes of patients undergoing CAS for asymptomatic or symptomatic carotid stenosis by a neurosurgeon or interventional neuroradiologist at our institution between 2008 and 2018. Patient and disease characteristics were recorded, as was the incidence of periprocedural and overall ischemia and mortality after CAS. Risk factors for recurrent ischemia and mortality were identified using a Cox proportional hazards model.
Results:
There were 238 patients who met inclusion criteria. Mean age was 69.7 years and most patients were male (69.7%); 62.2% underwent CAS for symptomatic carotid stenosis. The use of CAS for treatment of asymptomatic stenosis declined over the study period (P = 0.006). Fourteen patients (5.9%) experienced new or recurrent ipsilateral ischemia during follow-up, with 8 (3.4%) experiencing a stroke with permanent neurologic deficit. Fifty-nine patients (24.8%) died during follow-up, with a median time to death of 111.3 months (95% confidence interval [CI], 95.1-133.6) on Kaplan-Meier analysis. Increasing age at time of CAS (unit risk ratio, 1.05; 95% CI, 1.01-1.10; P = 0.011) and comorbid congestive heart failure (risk ratio, 2.40; 95% CI, 1.39-4.13; P = 0.002) were independent risk factors for mortality during follow-up.
Conclusions:
Unlike population-based studies, our results indicate acceptable long-term survival after CAS in adequately selected patients.
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