Demographic and Technical Risk Factors of 30-Day Stroke, Myocardial Infarction, and/or Death in Standard- and High-Risk Patients Who Underwent Carotid Angioplasty and Stenting

Abstract

Background: Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS. Materials and Methods: This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. Thirty-day stroke, myocardial infarction, and/or death were considered as the composite primary outcomes of the study. Results: A total of 251 patients were recruited (mean age: 71.1 ± 9.6 years; male: 65.3%). Of these, 178 (70.9%) were symptomatic, 73 (29.1%) were diabetic, 129 (51.4%) were hyperlipidemic, 165 (65.7%) were hypertensive, and 62 (24.7%) patients were smokers. CAS was performed for left internal carotid artery (ICA) in 113 (45.4%) patients. Fourteen (5.6%) patients had sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 ± 13.8%. An embolic protection device was used in 203 (96.2%) patients. Pre- and postdilation were performed in 39 (18.5%) and 182 (86.3%) patients, respectively. Composite outcomes were observed in 3.6% of patients (3.2% stroke, 0% myocardial infarction, and 1.2% death). Left-sided lesions and the presence of diabetes mellitus were significantly associated with poor short-term outcome (p = 0.025 and p = 0.020, respectively). Conclusion: There was a higher risk of short-term major complications in diabetic patients and for left carotid artery intervention.

Early and mid‐term outcomes of carotid angioplasty and stent placement in 579 patients

“…The CAS technical details including pre-and postoperative antiplatelet regimen; intraoperative anticoagulation regimen; and techniques for distal embolic protection device, pre-and postdilation, and stenting were the same as our previous publications. 4,7 Specifically, for patients with AF discontinuing anticoagulants and bridging therapy with heparin was considered.…”

“…CAS was first considered for high-risk patients for CEA, but it was gradually performed for standard-risk patients. 4 Although the annual number of CEA decreased and increased for CAS from 1998 to 2007 in the United States, 5 the advantage of CAS on aggressive medical treatment, particularly for asymptomatic patients, has been debated. 6 The most serious complications of CAS include transient ischemic attack (TIA), restenosis, ischemic strokes, intracerebral hemorrhage, myocardial infarction (MI), and mortality.…”

“…6 The most serious complications of CAS include transient ischemic attack (TIA), restenosis, ischemic strokes, intracerebral hemorrhage, myocardial infarction (MI), and mortality. 4,7,8 Previous studies in octogenarians have suggested an increased periprocedural risk of both stroke and death. 9 As the significant drawback of CAS compared to CEA is postprocedural minor ischemic strokes, [10][11][12][13] finding the predictors of postprocedural stroke is crucial for the best case selection.…”

“…The main treatment options for patients with carotid stenosis are medical therapy, surgical carotid endarterectomy (CEA), and endovascular carotid angioplasty and stenting (CAS). CAS was first considered for high‐risk patients for CEA, but it was gradually performed for standard‐risk patients 4 . Although the annual number of CEA decreased and increased for CAS from 1998 to 2007 in the United States, 5 the advantage of CAS on aggressive medical treatment, particularly for asymptomatic patients, has been debated 6 …”

Color Doppler Ultrasound of Carotid and Vertebral Vessels: Anatomy, Technique and Reporting

“…S troke is one of major diseases in different countries [1]. Despite of developed countries the age of incidence and mortality of stroke seems to be higher in Iran [2].Color Doppler study of carotid and vertebral arteries is a non-invasive, reliable and also easily available, cost-effective method for screening and follow up of patients at risk of stroke to differentiate patients need surgery or intervention from whom could be followed by medical management [3][4][5].It is a well-established and the most common imaging modality used for evaluation of carotid arteries diseases [6,7].…”