title: Factors Determining Periprocedural and Long-term Complications of High Risk Carotid Artery Stenting.
abstract: OBJECTIVE
  Carotid artery stenting (CAS) has been, historically, an alternative to open endarterectomy (CEA) for stroke prevention in high risk patients with carotid atherosclerosis. We sought to determine the rates of periprocedural and long-term stroke or death and the risk factors for complications after CAS in our high risk patient population.
  
  
  METHODS
  Clinical and treatment variables of consecutive CAS procedures performed between 2002 and 2011 were analyzed. Using univariate and multivariate logistic regression analyses we examined how patient characteristics influenced outcomes and changes in modified Rankin Score (mRS).
  
  
  RESULTS
  In 152 patients, the composite total of periprocedural death, stroke, transient ischemic attack (TIA) and myocardial infarction (MI) rate was 3.95% (6/152). Chronic kidney disease (CKD) was strongly associated with periprocedural complications (p<0.001). Coronary artery disease/peripheral vascular disease (CAD/PVD) (p=0.03), dyslipidemia (p=0.02), CKD (p=0.01), and contralateral internal carotid artery stenosis (p=0.02) were non-modifiable risk factors for mRS increase. There were 25 deaths, 8 strokes, 11 TIAs, and 1 MI (mean follow-up 38.4 months, range 0-116 months). The presence of CAD/PVD (p=0.009) and dyslipidemia (p=0.002) were significantly associated with long-term complications.
  
  
  CONCLUSIONS
  CAS was performed with low periprocedural complications in high-risk patients. Our rates compare very favorably to large-scale trials that have ideal patients. This data encourages the consideration of CAS in patients considered high risk for CEA and provides possible patient characteristics (CKD) to help with periprocedural risk stratification.
authors: 1Faculty of Medicine.
authors: Vincent
authors: V
authors: Dinculescu
authors: 5Royal College of Surgeons in Ireland,Dublin,Ireland.
authors: Anne C M
authors: AC
authors: Ritter
authors: 3Department of Diagnostic Imaging,The Ottawa Hospital,Ottawa.
authors: Marlise P
authors: MP
authors: dos Santos
authors: 4Department of Medical Imaging,University of Toronto,Toronto,Ontario,Canada.
authors: Ravi M
authors: RM
authors: Mohan
authors: 3Department of Diagnostic Imaging,The Ottawa Hospital,Ottawa.
authors: Betty A
authors: BA
authors: Schwarz
authors: 2Department of Neurosurgery,University of Ottawa.
authors: Howard J
authors: HJ
authors: Lesiuk
authors: 3Department of Diagnostic Imaging,The Ottawa Hospital,Ottawa.
authors: Cheemun
authors: C
authors: Lum
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D016893:Carotid Stenosis / Q000401:mortality* / Q000628:therapy*; D017023:Coronary Angiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: long term