title: Anatomic variables contributing to a higher periprocedural incidence of stroke and TIA in carotid artery stenting: single center experience of 833 consecutive cases.
abstract: OBJECTIVE
  This study was conducted to identify patient-related variables that are associated with a higher rate of neurological adverse events during carotid artery stenting (CAS).
  
  
  BACKGROUND
  CAS is considered as an alternative treatment for patients with carotid artery stenosis. Despite technical advancements and increase of operator experience, periprocedural neurologic complications cannot completely be prevented. Case selection based on anatomical criteria and other patient characteristics could improve the outcome after CAS.
  
  
  METHODS
  Between 2006 and 2009, 833 CAS procedures were performed in 751 consecutive patients under cerebral protection. The influence of patient characteristics, procedural details, and the anatomy of the supraaortic vessels on the incidence of major in-hospital adverse events was assessed.
  
  
  RESULTS
  Successful CAS was performed in 99.2% of the procedures. The in-hospital death and stroke rate was 2.0% (1 major stroke, 10 minor strokes, and 7 deaths). Octogenarians had a fourfold higher death and stroke rate than patients younger than 80 years old. There was an increased risk of stroke and death in patients with critical aortic stenosis. Presence of a bovine arch, tortous common carotid artery (CCA) and angulated distal internal carotid artery were associated with a higher risk of stroke and transient ischemic attack. A recently developed scoring system for anatomic suitability correlates well with the periprocedural neurological outcome in this case series.
  
  
  CONCLUSIONS
  Anatomical conditions and octogenarian age were associated with an increased rate of neurologic adverse events during CAS. Our findings support a newly proposed scoring system for anatomic suitability to identify patients at high risk for CAS.
authors.affiliation: Center of Vascular Medicine, Park Hospital, Leipzig, Germany. office@drwerner.eu
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bausback
authors.forename: Sven
authors.initials: S
authors.lastname: Bräunlich
authors.forename: Matthias
authors.initials: M
authors.lastname: Ulrich
authors.forename: Michael
authors.initials: M
authors.lastname: Piorkowski
authors.forename: Josef
authors.initials: J
authors.lastname: Friedenberger
authors.forename: Johannes
authors.initials: J
authors.lastname: Schuster
authors.forename: Spiridon
authors.initials: S
authors.lastname: Botsios
authors.forename: Dierk
authors.initials: D
authors.lastname: Scheinert
authors.forename: Andrej
authors.initials: A
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D001013:Aorta, Thoracic / Q000002:abnormalities; D002339:Carotid Arteries / Q000002:abnormalities*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality