A novel scoring system for identifying high-risk patients undergoing carotid stenting.
OBJECTIVE
In patients with severe concurrent coronary and carotid artery disease, two different treatment strategies may be used: simultaneous endarterectomy and coronary bypass surgery, and carotid stenting with delayed coronary bypass surgery after a few weeks. To evaluate the safety and efficacy of carotid stenting with delayed coronary bypass surgery after a few weeks in patients referred to Tehran Heart Center, Tehran, Iran and to determine the independent predictors that may be used to identify the appropriate treatment plan for such patients.


METHODS
This prospective study was performed from December 2003 through October 2004. Symptomatic patients with >60% stenosis and asymptomatic patients with >80% stenosis were included in this study. The risks and benefits of carotid stenting were explained. Patients were excluded from the study if any of the following was applicable: age > or =85 years, history of a major stroke within the last week, pregnancy, intracranial tumor or arteriovenous malformation, severely disabled as a result of stroke or dementia, and intracranial stenosis that exceeded the severity of the extracranial stenosis. Thirty consecutive patients who underwent carotid stenting were enrolled in this study.


RESULTS
The mean +/- SD age of patients was 66.3 +/- 8 years. The procedural success rate was 96.7%. During a mean +/- SD follow-up period of 5.6 +/- 3.2 months, 4 (17%) deaths occurred; none of which were attributed to a neurologic causes. Moreover, 1 (3%) patient developed a minor nonfatal stroke with transient cognitive disorder. Most of patients (80%) with major complications acquired a score of > or =26.


CONCLUSIONS
To reduce the rate of carotid stenting complications in high-risk patients with heart disease, to optimize the patient selections, and to determine the best treatment strategy, based on the clinical and lesion characteristics of patients, we proposed a new scoring system.
Kassaian
Seyed-Ebrahim
SE
Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. kassaian@tehranheartcenter.org
Kazemi-Saleh
Davood
D
Alidoosti
Mohammad
M
Salarifar
Mojtaba
M
Haji-Zeinali
Ali-Mohammad
AM
Hakki-Kazazi
Elham
E
Sahraian
Ali-Mohammad
AM
Gheini
Mohammad-Reza
MR
Abbasi
Seyed-Hesameddin
SH
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D006801:Humans; D007492:Iran; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome