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Updated: Jun 26, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Disability and associated outcomes among patients suffering periprocedural strokes after carotid artery stenting
Andrea Alonso1, Anna J Kobzeva-Herzog1, Scott R Levin1
1Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
Insights
Stroke after carotid artery stenting (CAS) can cause significant disability. Transfemoral CAS (TFCAS) carries a higher risk of 1-year mortality and neurological events compared to transcarotid artery revascularization (TCAR) following a stroke.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Perioperative stroke is a rare but serious complication of carotid artery stenting (CAS).
- The extent of disability and long-term consequences of post-CAS stroke are not well-defined.
- Understanding these outcomes is crucial for patient counseling and risk assessment.
Purpose of the Study:
- To evaluate the degree of disability resulting from stroke after transcarotid artery revascularization (TCAR) and transfemoral CAS (TFCAS).
- To assess the 1-year impact of post-CAS stroke on subsequent neurological events and mortality.
- To compare outcomes between TCAR and TFCAS in patients with asymptomatic carotid artery disease.
Main Methods:
- Analysis of the Vascular Quality Initiative CAS registry (2016-2023) for CAS procedures in asymptomatic patients.
- Stratification of stroke-related disability using the modified Rankin Scale (mRS) at discharge.
- Multivariable analysis to determine associations between early disability, stroke type, and 1-year outcomes (mortality, neurological events).
Main Results:
- Among 23,435 TCAR and 7,487 TFCAS procedures, periprocedural stroke rates were 0.80% (TCAR) and 0.92% (TFCAS).
- Severe early disability post-stroke was linked to significantly higher 1-year mortality (HR 11.04) and neurological event/death (HR 10.82).
- Strokes following TFCAS showed higher 1-year mortality (HR 1.27) and neurological event/death (HR 1.27) versus TCAR; hypertension increased severe disability risk, while aspirin/P2Y12 inhibitors decreased it.
Conclusions:
- A majority of patients experiencing perioperative stroke after TCAR or TFCAS for asymptomatic disease face substantial disability.
- Patients experiencing stroke after TFCAS have poorer 1-year outcomes compared to those after TCAR.
- These findings aid in patient-provider discussions about CAS risks and prognostication of postoperative stroke.
Objective:
Perioperative stroke after carotid artery stenting (CAS) is rare. However, the degree of disability and long-term effects from a postoperative stroke remain unclear. Our goal was to assess the degree of disability from a stroke after transcarotid artery revascularization (TCAR) and transfemoral CAS (TFCAS) for asymptomatic carotid artery disease, and the associated 1-year impact on subsequent neurological events and mortality.
Methods:
The Vascular Quality Initiative CAS registry (2016-2023) was queried for CAS performed for asymptomatic disease. Patients with a postoperative stroke had their disability stratified by modified Rankin score of 0 to 1 (mild), 2 to 3 (moderate), 4 to 5 (severe), and 6 (deceased). Postoperative stroke-related disability based on modified Rankin scale for those recorded at discharge and its association with long-term outcomes were analyzed.
Results:
There were 23,435 TCAR and 7487 TFCAS procedures performed for asymptomatic disease. Among TCAR patients, the periprocedural stroke and stroke/death rates were 0.80% and 1.03%, respectively, with disability distributed as 33.6% mild, 31.0% moderate, 28.9% severe, and 7.5% deceased. Among TFCAS patients, the periprocedural stroke and stroke/death rates were 0.92% and 1.19%, respectively, with disability distributed as 37.7% mild, 31.0% moderate, 27.5% severe, and 2.9% deceased. Multivariable analysis demonstrated that severe early postoperative disability was associated with increased 1-year mortality (hazard ratio [HR], 11.04; 95% confidence interval [CI], 6.9-17.7; P = .001) and increased subsequent neurological event/death (HR, 10.82; 95% CI, 6.93-16.9; P = .001). Patients with a stroke after TFCAS had a higher risk of 1-year mortality (HR, 1.27; 95% CI, 1.10, 1.47; P = .001) and neurological event/death (HR, 1.27; 95% CI, 1.11-1.45; P < .001), as compared with patients with a stroke after TCAR. Among patients who undergo a CAS procedure for asymptomatic disease, hypertension was associated with a higher likelihood of developing severe disability (odds ratio [OR], 4.2; 95% CI, 1.03-17.32; P = .045), whereas preoperative aspirin (OR, 0.51; 95% CI, 0.30-0.87; P = .01) or P2Y12 inhibitor use (OR, 0.45; 95% CI, 0.27-0.74; P = .11) was associated with a lower likelihood of developing a severe disability.
Conclusions:
The majority of patients who undergo TCAR and TFCAS for asymptomatic carotid artery disease who suffered a periprocedural stroke had substantial disability. Patients with strokes from TFCAS have worse 1-year outcomes as compared with patients with stroke after TCAR. These findings should help to guide patient-provider discussions regarding the surgical management of asymptomatic carotid stenosis and the risks of CAS interventions, as well as aid in the prognostication of postoperative stroke.
