Carotid artery stenting: do procedural complications relate to the side intervened upon?: results from the Carotid Artery Stent (CAS)-Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK).
OBJECTIVE
To determine the influence of the side intervened upon on outcomes during carotid artery stenting (CAS).


BACKGROUND
Anatomic and technical aspects may influence the results of CAS. The value of the side intervened upon has not been analyzed yet.


METHODS
We analyzed data from the Carotid Artery Stent (CAS)-Registry.


RESULTS
A total of 3,165 CAS procedures, 1,613 (51%) at the left and 1,552 (49%) at the right carotid artery were included. There was a higher proportion of patients treated for symptomatic stenoses when CAS was performed at the left carotid artery (50.1% versus 45.8%, P = 0.016) and more patients already had prior carotid endarterectomy (8.5% versus 5.8%, P = 0.003). Interventions at the left side took 3 min longer than interventions at the right side (46.6 +/- 24.3 versus 43.8 +/- 23.6, P = 0.003). In patients treated at the left carotid artery amaurosis fugax (0.7% versus 0.1%, P = 0.005), ipsilateral stroke (3.1% versus 1.8%, P = 0.017), and the primary endpoint of in-hospital death or stroke (4.1% versus 2.3%, P = 0.005) occurred significantly more often. Even after adjusting for confounding parameters, CAS procedures performed at the left carotid arteries remained an independent predictor of death or stroke (OR = 1.77, 95% CI: 1.15-2.72, P = 0.009).


CONCLUSIONS
In current clinical practice, CAS is performed frequently at the right carotid artery as at the left carotid artery. CAS interventions have a higher in-hospital complication rate if performed at the left carotid artery. Technical improvements might help to overcome this situation.
Herzzentrum Ludwigshafen, Kardiologie, Ludwigshafen, Germany. erzahn@aol.com
Ralf
R
Zahn
Thomas
T
Ischinger
Matthias
M
Hochadel
Bernd
B
Mark
Uwe
U
Zeymer
Wolfgang
W
Schmalz
Alexander
A
Schramm
Karl Eugen
KE
Hauptmann
Hubert
H
Seggewiss
Ilse
I
Janicke
Harald
H
Mudra
Jochen
J
Senges
D000368:Aged; D020757:Amaurosis Fugax / Q000209:etiology; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome