title: Beta-blocker use is associated with lower stroke and death after carotid artery stenting.
abstract: BACKGROUND
  Proper selection of patients for carotid artery stenting (CAS) remains controversial despite multiple controlled trials. This relates in part to differences in interpretation of the relative importance of myocardial vs stroke complications after the procedure by different specialties and a lack of granular clinical data to analyze outcomes outside the large clinical trials. The objective of this study was to assess the effect of preoperative medications, procedure parameters, and patient characteristics on outcomes of CAS performed in a multispecialty national database.
  
  
  METHODS
  We analyzed all patients who underwent CAS between 2005 and 2014 in the Vascular Quality Initiative. A multivariate logistic regression model was built to assess the effects of age, gender, comorbidities, smoking, preprocedure medications, procedure details, and hypotension or hypertension that required intravenous medication on 30-day death or stroke rates.
  
  
  RESULTS
  A total of 5263 patients underwent CAS (mean age, 70 years; 63% male). The 30-day stroke/death rate was 3.4% (1.5% minor stroke, 0.9% major stroke, and 1.2% death; 40% of patients who had major strokes died within 30 days), and the myocardial infarction rate was 0.8%. Postprocedural hypertension requiring treatment occurred in 519 cases (9.9%), and it was associated with a 3.4-fold increase in stroke/death (odds ratio, 3.39; 95% confidence interval, 2.30-5.00; P < .0001). Preprocedural beta-blocker use for >30 days was associated with a 34% reduction in the stroke/death risk (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P = .025) compared with nonuse. Beta-blocker use was not associated with postprocedural hypotension. Other predictors of postoperative stroke and death included age, symptomatic status, diabetes (type 1 or type 2), and postprocedural hypotension, whereas prior carotid endarterectomy and distal embolic protection use were protective.
  
  
  CONCLUSIONS
  Postprocedural hypertension and hypotension that require treatment are both strongly associated with periprocedural stroke/death after CAS. Beta blockers significantly reduce the stroke/death risk associated with carotid stenting and should be investigated prospectively for potential use during CAS.
authors.affiliation: Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Tammam
authors.initials: T
authors.lastname: Obeid
authors.affiliation: Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Isibor
authors.initials: I
authors.lastname: Arhuidese
authors.affiliation: Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Alicia
authors.initials: A
authors.lastname: Gaidry
authors.affiliation: Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Umair
authors.initials: U
authors.lastname: Qazi
authors.affiliation: Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Christopher
authors.initials: C
authors.lastname: Abularrage
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Philip
authors.initials: P
authors.lastname: Goodney
authors.affiliation: Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Jack
authors.initials: J
authors.lastname: Cronenwett
authors.affiliation: Division of Vascular and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md. Electronic address: bmalas1@jhmi.edu.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Malas
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists