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Updated: Aug 22, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Carotid Artery Stenting in Symptomatic Carotid Stenosis With Chronic Kidney Disease: A Single-Center Retrospective
Shanshan Liu1, Siyu Liu1, Juan Chen1
1Department of Cardiothoracic Vascular Surgery, Nanjing First Hospital, Nanjing Medical University, China.
Insights
Patients with early-stage chronic kidney disease (CKD) stages 2-3 undergoing carotid artery stenting (CAS) show good long-term event-free survival (EFS). However, advanced CKD stages 4-5 patients have poor EFS after CAS, suggesting limited benefit.
Area of Science:
- Nephrology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Symptomatic carotid artery stenosis poses a significant risk of stroke.
- Chronic kidney disease (CKD) is a prevalent comorbidity affecting cardiovascular outcomes.
- The impact of CKD stage on event-free survival (EFS) after carotid artery stenting (CAS) requires further investigation.
Purpose of the Study:
- To evaluate short- and long-term EFS in patients with varying stages of CKD undergoing CAS.
- To compare EFS outcomes between different CKD stages (2-5) following CAS for symptomatic carotid artery stenosis.
Main Methods:
- A retrospective, single-center study of 1363 patients with symptomatic carotid artery stenosis treated with CAS.
- Patients were stratified into CKD stages 2, 3, 4, and 5 based on glomerular filtration rate.
- Primary endpoint was 10-year EFS (stroke, myocardial infarction, or death); secondary outcomes included perioperative major adverse events.
Main Results:
- Perioperative event rates increased with CKD severity, ranging from 1.8% (stage 2) to 10.3% (stage 4).
- Ten-year EFS was significantly lower in advanced CKD stages 4-5 (36.3%) compared to early stages 2-3 (70.4%).
- Kaplan-Meier analysis showed no significant difference in EFS between CKD stages 2 and 3, but a marked decline in stages 4 and 5 (log-rank P < .001).
Conclusions:
- Patients with CKD stages 2-3 undergoing CAS experience favorable long-term event-free survival.
- Patients with advanced CKD stages 4-5 demonstrate poor long-term EFS, suggesting limited life expectancy and reduced benefit from CAS.
- CAS decision-making for symptomatic carotid stenosis in CKD patients should be individualized, with cautious consideration of risks and benefits, particularly in advanced CKD stages.
Objective:
To investigate the short- and long-term event-free survival (EFS) in patients with chronic kidney disease (CKD) undergoing carotid artery stenting (CAS) for the treatment of symptomatic carotid artery stenosis.
Method:
The single-center retrospective study included 1363 patients, who were categorized into CKD stages 2, 3, 4, and 5 based on their glomerular filtration rate. The primary endpoint was long-term EFS from the occurrence of stroke, myocardial infarction (MI), or death within a 10-year follow-up period. Secondary outcomes included perioperative major adverse events, such as any stroke, MI, death, or transient ischemic attacks (TIAs) occurring within 30 days after CAS.
Results:
Perioperative event rates were 1.8%, 3.0%, 10.3%, and 8.7% across the 4 cohorts. The estimated rates of EFS were 96.1% versus 86.7% versus 78.4% versus 63.5% at 3 years, 91.0% versus 80.2% versus 65.2% versus 49.5% at 5 years and 78.0% versus 70.4% versus 54.8% versus 36.3% at 10 years. Kaplan-Meier analysis reported that the long-term EFS did not differ between patients with stage 2 and stage 3 CKD (107.79 months 95% confidence interval [CI]: 104.64, 110.95 vs 97.20 months, 95% CI, 90.71-103.69), whereas EFS was lower in patients with stage 4 and stage 5 CKD (67.04 months, 95% CI, 61.15-72.93 vs 58.56 months, 95% CI, 48.20-68.91) (log-rank P < .001).
Conclusion:
Patients with stage 2 to 3 CKD benefited from long-term EFS following invasive CAS. In contrast, those with stage 4 to 5 CKD exhibited poor long-term EFS or reduced life expectancy limiting the prevention of events over a 10-year follow-up period. Cautious consideration of the potential benefits was necessary when planning CAS even in symptomatic cases.Clinical ImpactThis study provided real-world 10-year follow-up evidence to refine CAS decision-making for symptomatic carotid stenosis patients with CKD. Clinicians could stratify candidates by CKD stages: stage 2-3 patients were recommended for CAS to gain satisfying long-term event-free survival, while for stage 4-5 patients, cautious, individualized benefit-risk assessment was required before intervention. The innovation lied in its large-sample, stage-stratified long-term outcome data filling the relevant gap in Chinese CKD population, guiding clinicians to avoid over-treatment for advanced CKD patients with limited life expectancy.
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