title: Predictors of carotid occlusion intolerance during proximal protected carotid artery stenting.
abstract: OBJECTIVE
  The aim of this study was to identify predictors of occlusion intolerance (OI) developing during proximal protected carotid artery stenting (CAS).
  
  
  BACKGROUND
  The use of proximal embolic protection devices, such as endovascular occlusion, during CAS has been demonstrated to be particularly safe and effective. However, endovascular occlusion can expose the ipsilateral hemisphere to hypoperfusion and produce transient neurological symptoms (OI).
  
  
  METHODS
  From March 2010 to March 2012, 605 consecutive patients underwent proximal protected CAS at our institution. To identify independent predictors of OI, a multivariate logistic regression model was developed that included all patients' clinical/angiographic and procedural characteristics.
  
  
  RESULTS
  OI developed in a total of 184 patients (30.4%). Compared with patients in whom OI did not develop, those who experienced OI had lower occlusion pressure (OP) (42.3 ± 12.7 mm Hg vs. 61.9 ± 15.4 mm Hg, p < 0.001). Receiver-operating characteristic curve analysis demonstrated that OP was the most consistent predictor of OI with a C-statistic of 0.85 (95% confidence interval [CI]: 0.82 to 0.88) with best cutoff being ≤40 mm Hg (sensitivity, 68.5%; specificity, 93.3%). By logistic regression analysis, the most powerful independent predictor of OI developing was an OP ≤40 mm Hg (odds ratio: 33.2, 95% CI: 19.1 to 57.7) and the most powerful clinical predictor of such OP was the presence of contralateral internal carotid artery occlusion (odds ratio: 3.1, 95% CI: 1.5 to 6.2).
  
  
  CONCLUSIONS
  OI may occur in as many as one-third of the patients undergoing proximal protected CAS. This event is more common in those patients with an OP ≤40 mm Hg. Patients presenting with concomitant occlusion of the contralateral internal carotid artery more frequently have an OP ≤40 mm Hg.
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giugliano
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. Electronic address: geko50@hotmail.com.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Stabile
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Biamino
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Petroni
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Sannino
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Brevetti
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Pucciarelli
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Grigore
authors.initials: G
authors.lastname: Popusoi
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Tesorio
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Cioppa
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Linda
authors.initials: L
authors.lastname: Cota
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Salemme
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sorropago
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Ausania
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Della Pietra
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Arturo
authors.initials: A
authors.lastname: Fontanelli
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
authors.affiliation: Montevergine Clinic, Mercogliano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rubino
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D019540:Area Under Curve; D002343:Carotid Artery, Internal / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: carotid artery stenting; endovascular occlusion; occlusion intolerance