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

Full Text via DOI: 10.1161/CIRCINTERVENTIONS.110.950097 PMID: 21098744 Web of Science: 000285296100011
Industry Collaboration

Cited authors

  • Aronow, Herbert D.; Gray, William A.; Ramee, Stephen R.; Mishkel, Gregory J.; Schreiber, Theodore J.; Wang, Hong

Abstract

  • 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. (Circ Cardiovasc Interv. 2010;3:577-584.)

Authors

Publication date

  • 2010

Published in

International Standard Serial Number (ISSN)

  • 1941-7640

Start page

  • 577

End page

  • 584

Volume

  • 3

Issue

  • 6