Anatomic variables contributing to a higher periprocedural incidence of stroke and TIA in carotid artery stenting

Abstract

Anatomical conditions and octogenarian age were associated with an increased rate of neurologic adverse events during CAS. Our findings support a newly proposed scoring system for anatomic suitability to identify patients at high risk for CAS.

High-Risk Factors in Symptomatic Patients Undergoing Carotid Artery Stenting With Distal Protection

“…This included stroke (3.2%), MI (3.2%), and death (1.4%). Compared with other studies comprising both symptomatic and asymptomatic patients with carotid stenosis who underwent CAS, our rate of complications falls well within the range established in the literature (Table 8 7,9,[19][20][21][22][23][24][25][26][27][28]. However, all patients included in our study had symptomatic carotid artery disease, which is a noteworthy difference from the studies in Table 8.…”

“…24 In other studies, bovine arch anatomy correlated with increased risk of stroke, resulted in technical failure and CAS abortion, or was a contraindication to left-sided CAS. 23,24,27,43 In our study, the presence of a diseased aortic arch was a significant risk factor for 30-day stroke (P = .02; correlation coefficient = 0.157), as was the presence of type III aortic arch (P = .04; correlation coefficient = 0.140). However, neither reached statistical significance when all anatomic variables in the multivariate logistic regression were accounted for.…”

“…In fact, several studies have shown that patients with asymptomatic carotid disease have significantly fewer complications than those with symptomatic disease (Table 9). 25,27,29,30 …”

“…42 Similarly, severe tortuosity of the CCA and significant angulation of the ICA origin were correlated with an increased risk of stroke in an unselected population of 751 patients who underwent 833 CAS procedures. 27 Moreover, several authors were forced to abort CAS cases because of severe ICA tortuosity. 19,23,53 In fact, some authors determined severe carotid tortuosity to be one of the contraindications to CAS, whereas others strongly advocated CEA when carotid tortuosity exceeded 90°.…”

Results of carotid angioplasty and stenting are equivalent for critical versus high-grade lesions in patients deemed high risk for carotid endarterectomy

“…Because the conduct of CAS mandates manipulation of arteries other than the carotid, it is posited that the unfavorable anatomy commonly seen in the elderly population, which was not the focus of our investigation, may contribute to the worse outcomes reported in this patient subgroup [22e24]. Werner et al [25] retrospectively reviewed a series of 833 CAS procedures using embolic protection and found the presence of bovine arch, tortuous common carotid artery, or angulated distal internal carotid artery to be associated with a higher risk of stroke and transient ischemic attack. A second study also noted aortic arch calcification and common carotid stenosis to be additional features of complex anatomy seen in older patients [26].…”