title: High-risk anatomic variables and plaque characteristics in carotid artery stenting.
abstract: OBJECTIVE
  To determine anatomic and plaque-related risk factors for patients undergoing carotid artery stenting.
  
  
  METHODS
  A retrospective review of patients from a prospectively maintained database undergoing carotid artery stenting at our institution between 2001 and 2010 was performed. Preoperative imaging studies (ie, ultrasound, computed tomography angiography, magnetic resonance angiography, and angiograms) were reviewed for specific anatomic criteria and plaque characteristics. Primary outcomes included 30-day stroke or transient ischemic attack (TIA). Secondary outcomes included 30-day death and myocardial infarction (MI). Statistical significance was assumed for P = .05.
  
  
  RESULTS
  Imaging was reviewed for 381 carotid arteries in 375 patients. There were 14 (3.7%) perioperative neurologic events, which included 8 TIA and 6 strokes. Thirty-day mortality and MI were 0.5% and 0.75%, respectively. Degree of internal carotid artery stenosis was associated with primary outcomes (P = .03), and the presence of arch calcification trended toward an increase in primary outcomes (P = .07). However, arch type, ostial involvement, tandem lesions, and plaque calcification did not correlate with primary outcomes. Differences were noted between the sexes, with females having more common carotid artery tortuosity than males (34% vs 27%, P = .04). Females also had a trend toward more plaque calcification and more severe arch calcification than males. These differences did not translate to differences in perioperative neurologic events.
  
  
  CONCLUSIONS
  Our data suggest that degree of internal carotid artery stenosis and aortic arch calcification may be associated with increased perioperative neurologic risk during carotid stenting, but arch type is not.
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Morgan
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Cheong J
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Chin
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Eskandari
authors.affiliation: Department of Vascular Surgery, St Vincent Healthcare, Billings, MT, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Morasch
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Heron E
authors.initials: HE
authors.lastname: Rodriguez
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Irene B
authors.initials: IB
authors.lastname: Helenowski
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Vascular Surgery, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA mkibbe@nmh.org.
authors.forename: Melina R
authors.initials: MR
authors.lastname: Kibbe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001013:Aorta, Thoracic / Q000473:pathology*; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D002343:Carotid Artery, Internal / Q000473:pathology*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002641:Chicago; D016208:Databases, Factual; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications* / Q000175:diagnosis / Q000401:mortality
keywords: arch type; calcification; carotid artery; carotid artery stenting