Predictors of Neurological Events Associated With Carotid Artery Stenting in High-Surgical-Risk Patients: Insights From the Cordis Carotid Stent Collaborative

BACKGROUND—Comorbid and anatomic characteristics that portend higher procedural risk are well defined for carotid endarterectomy but less so for carotid artery stenting. METHODS AND RESULTS—We pooled carotid stent data from 4 Cordis-sponsored trials (n=2104) with similar patient cohorts and end poin...

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Published in:	Circulation. Cardiovascular interventions Vol. 3; no. 6; pp. 577 - 584
Main Authors:	Aronow, Herbert D, Gray, William A, Ramee, Stephen R, Mishkel, Gregory J, Schreiber, Theodore J, Wang, Hong
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD American Heart Association, Inc 01-12-2010 Lippincott Williams & Wilkins
Subjects:	Age Factors Aged Aged, 80 and over Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Carotid Stenosis - therapy Clinical Trials as Topic Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Humans Male Medical sciences Multivariate Analysis Neurology Neurosurgery Risk Skull, brain, vascular surgery Stents - adverse effects Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Vascular diseases and vascular malformations of the nervous system Endocrinopathy Relapse Prognosis Renal artery stents Stenosis Cardiovascular disease Lipids Hyperlipoproteinemia Lipoprotein Duplex ultrasonography Stent Vascular disease Surgery Race Arteriography Dyslipemia Endarteriectomy Cerebrovascular disease Human Endoprosthesis Nervous system diseases Stroke Diabetes mellitus Glycoprotein Negroid Metabolic diseases carotid arteries Coronary heart disease Cholesterol Cerebral disorder Restenosis Logistic regression follow-up studies Hypercholesterolemia Follow up study Protamine Carotid Central nervous system disease Risk factor
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Summary:	BACKGROUND—Comorbid and anatomic characteristics that portend higher procedural risk are well defined for carotid endarterectomy but less so for carotid artery stenting. METHODS AND RESULTS—We pooled carotid stent data from 4 Cordis-sponsored trials (n=2104) with similar patient cohorts and end point determination to identify predictors of neurological death or stroke within 30 days of the procedure. Median age was 74 years (24% >80 years), 36% were women, and 24.2% were symptomatic in the previous 6 months. There were 88 (4.2%) neurological deaths or strokes at 30 days. Among symptomatic patients, the risk of adverse neurological outcome declined with increasing time between the incident neurological event and carotid stent procedure. In a logistic regression model that included preprocedural and procedural variables, significant multivariable predictors of 30-day neurological death or stroke were older age (continuous), black race, angiographically visible thrombus in symptomatic patients, procedural use of glycoprotein IIb/IIIa inhibitors, procedural transient ischemic attack, final residual stenosis >30%, and periprocedural use of protamine or vasopressors. CONCLUSIONS—In this pooled analysis, a number of preprocedural and procedural factors predicted higher risk of stroke and neurological death within 30 days of a carotid stent procedure. Identification of such predictors may help to guide patient selection and further refine procedural technique.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1941-7640 1941-7632
DOI:	10.1161/CIRCINTERVENTIONS.110.950097