title: Predictors of neurological events associated with carotid artery stenting in high-surgical-risk patients: insights from the Cordis Carotid Stent Collaborative.
abstract: BACKGROUND
  Comorbid and anatomic characteristics that portend higher procedural risk are well defined for carotid endarterectomy but less so for carotid artery stenting.
  
  
  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.
authors.affiliation: Michigan Heart and Vascular Institute, Ann Arbor, MI, USA. haronow@michiganheart.com
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.forename: William A
authors.initials: WA
authors.lastname: Gray
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Ramee
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Mishkel
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Schreiber
authors.forename: Hong
authors.initials: H
authors.lastname: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000628:therapy*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012306:Risk; D015607:Stents / Q000009:adverse effects