Predictors of death and stroke after carotid angioplasty and stenting: a subgroup analysis of the Pro-CAS data.
OBJECTIVE
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 (< or = 50 versus 51 to 150 versus > or = 151 interventions), age, prior symptoms, primary intervention as compared with intervention for restenosis, angioplasty without stent, predilatation, and heparin dosage > 5000 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.
Theiss
Wolfram
W
Medizinische Klinik der Technischen Universität, Heubergstr. 12, Munich D-81825, Germany. wolfram.theiss@gmx.de
Hermanek
Peter
P
Mathias
Klaus
K
Brückmann
Hartmut
H
Dembski
Jürgen
J
Hoffmann
Franz-Josef
FJ
Kerner
Rüdiger
R
Leisch
Franz
F
Mudra
Harald
H
Schulte
Karl-Ludwig
KL
Sievert
Horst
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000401:mortality*; D002340:Carotid Artery Diseases / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality* / Q000601:surgery / Q000628:therapy*