Predictors of Death and Stroke After Carotid Angioplasty and Stenting

Abstract

Background and Purpose-Little is known about the significance of patient characteristics, clinical indications, and technical details on the risk of carotid angioplasty and stenting (CAS). The purpose of this study was to test these parameters as to their predictive value for the peri-interventional risk of CAS. Methods-Pro-CAS is a prospective, multicenter registry of CAS. Logistic regression analysis of possible predictive factors was performed on 5341 interventions that had been entered by 25 clinical centers between July 1999 and June 2005. Results-The combined in-hospital mortality and stroke rate was 3.6%. The following were found to be significant predictors of peri-interventional stroke and death: center experience (Յ50 versus 51 to 150 versus Ն151 interventions), age, prior symptoms, primary intervention as compared with intervention for restenosis, angioplasty without stent, predilatation, and heparin dosage Ͼ5000 IU. No statistically significant result was found for year of intervention, patient volume, gender, interval between symptoms and CAS, ocular versus neurological symptoms, side of CAS, degree of stenosis of the target lesion, presence of contralateral high-degree stenosis or occlusion, method of gaining access to the carotids, stent type, and use of a protection system. Conclusions-Our findings underline the need for dedicated training and strict credentialing rules for CAS. In addition, they might help to identify subgroups of patients at differential risk for CAS and carotid endarterectomy and yield a basis for correcting risks due to differences in case mix in reports about CAS.

The impact of regulatory approval and Medicare coverage on outcomes of carotid stenting

“…This confirms previous reports indicating a learning curve for carotid stenting [21][22][23][24], and is in keeping with multiple reports of the same phenomenon in CEA and other endovascular therapies [25][26][27].…”

Carotid Artery Stenting in Clinical Practice: Does Sex Matter? Results From the Carotid Artery Stenting Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

“…15 In their statistical subgroup analysis, sex also was not an independent predictor of peri-interventional stroke or death. 15 Theiss et al reported a periprocedural stroke or death rate in 3.5% of men and 3.0% of women undergoing CAS (P = 0.42), which corresponds nicely to our peri-interventional death or stroke rates of 3.4% in women and 3.0% in men treated with CAS (P = 0.47) in a comparable population in clinical practice. In addition, several randomized clinical trials (SPACE, CREST, International Carotid Stenting Study [ICSS]) comparing CAS to CEA also did not show a significant impact of sex on the outcome of patients undergoing CAS.…”

“…The risk for procedure-related complications and clinical outcome in CAS may depend on various factors, for example the center experience, the patient's age, and previous intervention on the vessel. 15 Knowing these risk factors may lower the risk for periprocedural complications in the future and make CAS an even safer procedure. A possible impact of the patient's sex on the outcome of the CAS in clinical practice has not been investigated in detail, and only little information about this topic is available so far.…”

Systematic Review of Carotid Artery Procedures and the Volume-Outcome Relationship in Europe

“…Five studies reported the relationship using UK data sources 11,15,16,18,19,21 Nine studies [11][12][13][14][15][16][17][20][21][22] analysis of data collected as part of an administrative database.…”

“…Kuehnl et al 14 conducted a range of adjusted and unadjusted analyses and found no association (Table 5). Two smaller studies 17,22 found evidence of a statistically significant relationship between CAS volume and combined mortality and stroke in unadjusted analyses. These positive correlations were not replicated in multi-variate analysis adjusted for temporal trends, patient and operative factors and cumulative institutional experience (distinct from a caseload count in a fixed period) 22 .…”