Prognostic Factors for Neurologic Outcome in Patients with Carotid Artery Stenting.
BACKGROUND
Carotid artery stenting (CAS) is a valid treatment for patients with carotid artery stenosis. The long-term outcome and prognostic factors in Asian population after CAS are not clear. This study aimed to identify the prognostic factors among Asian patients who have undergone CAS.


METHODS
We retrospectively analyzed 246 patients with CAS. Annual carotid duplex ultrasound was used to identify restenosis. Peri-procedural complications, restenosis, neurologic outcomes, and mortality were recorded. Cox regression analyses were used to identify prognostic factors.


RESULTS
The mean follow-up time was 49.2 months. Procedural success was achieved in 237 patients (98.3%), and protection devices were used in 208 patients (84.5%). Within 30 days of CAS, 13 (4.3% per procedure) peri-procedural complications occurred. During the follow-up period, 24 (9.7%) patients developed restenosis, and 37 (15.0%) developed ischemic strokes. In a multiple logistic regression analysis, head and neck radiotherapy [hazard ratio (HR) = 9.9, 95% confidence interval (CI), 3.38-29.1, p < .001], stent diameter (HR = 0.72, 95% CI, 0.58-0.89, p = .003), and predilatation (HR = 3.08 95% CI, 1.21-7.81, p = .018) were independent predictors for restenosis. In Cox regression analysis, hypercholesterolemia (HR = 0.25, 95% CI, 0.07-0.94, p = .04), head and neck radiotherapy (HR = 6.2, 95% CI, 1.8-21.3, p = .004), and restenosis (HR = 3.6, 95% CI, 1.1-11.18, p = .04) were predictors for recurrent ipsilateral ischemic stroke.


CONCLUSIONS
CAS provides reliable long-term results in Asian patients with carotid stenosis. Restenosis is associated with an increased rate of recurrent stroke and should be monitored carefully following CAS.


BACKGROUND
Carotid artery disease • Prognosis • Cerebrovascular disease.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chi-Sheng
CS
Hung
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Mao-Shin
MS
Lin
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ying-Hsien
YH
Chen
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ching-Chang
CC
Huang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hung-Yuan
HY
Li
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hsien-Li
HL
Kao