title: Older age and greater carotid intima-media thickness predict ischemic events associated with carotid-artery stenting.
abstract: BACKGROUND
  Carotid-artery stenting (CAS) may be complicated by stroke. We aimed to determine predictors of procedure-related ischemic events.
  
  
  METHODS
  We analyzed new ischemic lesions in diffusion-weighted MRI (DWI) after CAS in 147 patients with symptomatic high-grade carotid stenosis. Nine covariates were assessed as potential risk factors for new lesions in DWI: age, gender, hypertension, diabetes, dyslipidemia, smoking status, severity of stenosis, side of intervention and carotid intima-media thickness (IMT).
  
  
  RESULTS
  From the nine covariates assessed, only age and IMT were independently associated with new DWI lesions. An age of 68 years and an IMT of 1.5 mm gave the best separation between high- and low-risk populations. The subgroup of patients <68 years who had an IMT ≤1.5 mm had the lowest rate of new DWI lesions (11.3%). This rate was greater in patients ≥68 years (30.0%; odds ratio, OR, 3.4; 95% confidence interval, CI, 1.1-10.8) and in patients with an IMT >1.5 mm (36.4%; OR 4.5; 95% CI 1.2-17.0) and was particularly high in patients aged ≥68 years with IMT >1.5 mm (69.6%; OR 18.0; 95% CI 4.8-71.9).
  
  
  CONCLUSIONS
  Older age and greater IMT are independently associated with the risk of CAS-related ischemic events. This risk is particularly high in those patients in whom older age and greater IMT coincide.
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. rosenkranz@uke.de
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenkranz
authors.forename: Götz
authors.initials: G
authors.lastname: Thomalla
authors.forename: Stefanie
authors.initials: S
authors.lastname: Havemeister
authors.forename: Oliver
authors.initials: O
authors.lastname: Wittkugel
authors.forename: Bastian
authors.initials: B
authors.lastname: Cheng
authors.forename: Anna
authors.initials: A
authors.lastname: Krützelmann
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.forename: Christian
authors.initials: C
authors.lastname: Gerloff
mesh_terms: D000367:Age Factors; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology*; D018608:Ultrasonography, Doppler