Carotid Artery Stenting Outcomes in Comprehensive Stroke Hospitals (CASSH): A Prospective Multicenter Study

Area of Science:

• Vascular Surgery
• Interventional Neurology
• Cardiovascular Medicine

Background:

• The CASONI study indicated that neurointerventional surgeon experience reduces carotid artery stenting complications.
• The CASSH study aims to validate and expand on CASONI findings in a real-world setting.

Purpose of the Study:

• To prospectively evaluate real-world carotid artery stenting outcomes.
• To assess outcomes performed by fellowship-trained neurointerventionalists at comprehensive stroke centers.

Main Methods:

• A multicenter, prospective observational study involving 889 patients across 15 US comprehensive stroke centers.
• Included adults with symptomatic (≥50%) or asymptomatic (≥70%) carotid stenosis.
• Primary outcome: 30-day composite of death, stroke, or myocardial infarction; secondary outcomes included complications and mortality.

Main Results:

• The 30-day composite primary outcome occurred in 1.2% of patients.
• Access site complications (1.7%) and nonprocedural mortality (1.5%) were the most common secondary outcomes.
• Higher preprocedural disability, stroke severity, and longer fluoroscopy times were associated with increased complication risk. Postprocedural antiplatelet therapy showed protective effects.

Conclusions:

• Carotid artery stenting by fellowship-trained neurointerventionalists at comprehensive stroke centers is associated with low periprocedural event rates.
• Outcomes align with the CREST-2 trial, especially in asymptomatic patients.
• Preprocedural disability, stroke severity, age, and cardiac function significantly influence outcomes, highlighting the importance of patient selection and perioperative care.