Carotid artery stenting: identification of risk factors for poor outcomes.
OBJECTIVE
Age greater than 80 has been identified as a risk factor for complications, including stroke and death, in patients undergoing carotid artery angioplasty and stenting (CAS). This study evaluates other potential predictors of perioperative complications in patients undergoing CAS.


METHODS
All cerebrovascular endovascular procedures performed by the vascular surgery division at our university hospital between July 2003 and December 2005 were retrospectively examined. During the course of 212 admissions, 198 patients underwent 215 procedures. Patient age, comorbidities, and admission status were analyzed as independent (predictor) variables. Complication rate, discharge disposition, and length of hospital stay were considered dependent (outcome) variables. Logistic regression and Fisher exact test or Student t test were performed, as appropriate.


RESULTS
Complications included major and minor stroke, myocardial infarction, femoral artery pseudoaneurysm, and death. The rates of perioperative major and minor stroke were 0.5% and 2.8%, respectively. Chronic renal insufficiency was a predictor of perioperative complications, including stroke: patients with serum creatinine greater than 1.3 mg/dL had a 37% complication rate and a 11.1% stroke rate, while those with normal renal function had a 13% complication rate (P = .003) and a 0.6% stroke rate (P =.001). Similar association was seen between creatinine clearance and both stroke and complications. Obesity was a risk factor for complications, but not stroke: obese patients had a complication rate of 28%, while others had a 16% complication rate (P = .024). Emergency admission predicted both extended hospital stay (P < .001) and requirement for further inpatient care in a rehabilitation or nursing facility (P = .007). There was no significant difference in complication rate or stroke rate between octogenarians and others.


CONCLUSIONS
This experience demonstrates that chronic renal insufficiency, obesity, and emergent clinical setting are risk factors for patients undergoing CAS.
Jackson
Benjamin M
BM
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. benjamin.jackson@uphs.upenn.edu
English
Sean J
SJ
Fairman
Ronald M
RM
Karmacharya
Jagajan
J
Carpenter
Jeffrey P
JP
Woo
Edward Y
EY
D000368:Aged; D000800:Angioplasty, Balloon; D016893:Carotid Stenosis / Q000453:epidemiology / Q000628:therapy*; D004632:Emergency Medical Services; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome