Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI)

Area of Science:

• Vascular Surgery
• Interventional Neurology
• Cardiovascular Medicine

Background:

• Operator experience is crucial for carotid artery stenting (CAS) outcomes.
• Fellowship-trained neurointerventionalists are under-represented in CAS literature.
• This study focuses on the complication rates of CAS performed exclusively by neurointerventionalists.

Purpose of the Study:

• To report the complication rate of carotid artery stenting (CAS).
• To evaluate CAS outcomes exclusively performed by neurointerventionalists.
• To compare complication rates with existing literature on CAS and alternative procedures.

Main Methods:

• Retrospective cohort study of CAS procedures at multiple comprehensive stroke centers.
• Analysis of 1281 patients with 30-day outcomes.
• Primary outcome: composite of mortality, stroke, hemorrhage, and myocardial infarction; secondary outcomes: other complications.

Main Results:

• 1445 CAS procedures were performed by 38 neurointerventionalists between 2018-2022.
• The primary composite outcome occurred in 1.8% of cases (26/1281).
• Complications were associated with advanced age, female sex, aortic arch type 3, higher mRS, and lower diastolic blood pressure.

Conclusions:

• Carotid artery stenting by fellowship-trained neurointerventionalists in stroke centers has a low complication rate.
• This rate is lower than previously reported for CAS, carotid endarterectomy, and transcarotid artery revascularization.
• Physician training, procedure frequency, and standardized stroke care likely contribute to favorable outcomes.