Vaskulárna medicína 2/2016

Identification of periprocedural risks of carotid stenting in selected populations

Aim of the study:The optimal treatment of carotid artery stenosis, despite many studies, is still being discussed. The aim of study performed at the Angiology Department Cardiology Clinic VÚSCH Kosice was to identify the risk of periprocedural complications, depending on demographic and clinical factors and to analyse the impact of these factors on all-cause mortality in the group of patients treated with carotid artery stenting. Methods:We performed retrospective study of 502 patients treated with protected carotid artery stenting between June 20, 2008 and December 31, 2015. Mean age of patients was 67.2 ± 8.4 years, mean follow-up was 1 054 days (547.3; 1 454.8). Demographic characteristics, laboratory parameters, comorbidities and the incidence of periprocedural complications stroke and death within 30 days after CAS were examined from patient records. Results:During periprocedural period (within 30 days of CAS) stroke/death occurred in 3.8 % of patients (n = 19). Stroke/death in symptomatic carotid stenosis patients occured in 5,4 % of cases (n = 10), in asymptomatic carotid stenosis in 2,8 % of cases (n = 9). Advanced age ≥ 75 years was associated with 3.0-times higher risk of periprocedural stroke/death compared with younger patients. Ischemic stroke > 6 months before CAS was associated with 3.4-times higher risk of periprocedural stroke/death compared with patients without this diagnosis. During follow-up all-cause mortality was 1.8-times higher in group of patients with coronary artery disease (CAD), 1.6-times higher in patients with diabetes mellitus (DM) and 1.6-times higher in patients with ischemic stroke > 6 months before CAS compared with patients without these diseases in univariable analysis. Adjusted all-cause mortality was in patients with ischemic stroke > 6 months before CAS 1.5-higher compared with patients without ischemic stroke > 6 months before CAS, but not in DM and CAD patients. Conclusion:The incidence of periprocedural complications after carotid artery stenting is acceptable in the center with sufficient experience and confirms the suitability of this method as an alternative to carotid endarterectomy in properly-selected patients. In patients older than 75 years compared with younger we confirmed higher periprocedural risk of stroke/death. Compared to patients without ischemic stroke >6 months before CAS, patients with ischemic stroke >6 months before the CAS have increased risk of periprocedural stroke/death and higher all-cause mortality.

Keywords: carotid stenting, stroke, complications