title: First-ever ischemic stroke in elderly patients: predictors of functional outcome following carotid artery stenting.
abstract: Age is an important risk factor for stroke, and carotid artery stenosis is the primary cause of first-ever ischemic stroke. Timely intervention with stenting procedures can effectively prevent secondary stroke; however, the impact of stenting on various periprocedural physical functionalities has never been thoroughly investigated. The primary aim of this study was to investigate whether prestenting characteristics were associated with long-term functional outcomes in patients presenting with first-ever ischemic stroke. The secondary aim was to investigate whether patient age was an important factor in outcomes following stenting, measured by the modified Rankin scale (mRS). In total, 144 consecutive patients with first-ever ischemic stroke who underwent carotid artery stenting from January 2010 to November 2014 were included. Clinical data were obtained by review of medical records. The Barthel index (BI) and mRS were used to assess disability before stenting and at 12-month follow-up. In total, 72/144 patients showed improvement (mRS[+]), 71 showed stationary and one showed deterioration in condition (mRS[-]). The prestenting parameters, ratio of cerebral blood volume (1.41 vs 1.2 for mRS[-] vs mRS[+]), BI (75 vs 85), and high-sensitivity C-reactive protein (hsCRP 5.0 vs 3.99), differed significantly between the two outcome groups (P<0.05). The internal carotid artery/common carotid artery ratio (P=0.011), BI (P=0.019), ipsilateral internal carotid artery resistance index (P=0.003), and HbA1c (P=0.039) were all factors significantly associated with patient age group. There was no significant association between age and poststenting outcome measured by mRS with 57% of patients in the ≥75 years age group showing mRS(-) and 43% showing mRS(+) (P=0.371). Our findings indicate that in our elderly patient series, carotid artery stenting may benefit a significant proportion of carotid stenotic patients regardless of age. Ratio of cerebral blood volume, BI, and admission hsCRP could serve as important predictors of mRS improvement and may facilitate differentiation of patients at baseline.
authors.affiliation: Department of Neurology, Stroke Center, Changhua Christian Hospital, Changhua; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Lin
authors.affiliation: Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua.
authors.forename: Yu-Jun
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Department of Medical Imaging, Changhua Christian Hospital, Changhua.
authors.forename: Chi-Kuang
authors.initials: CK
authors.lastname: Liu
authors.affiliation: Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Cheng-Sheng
authors.initials: CS
authors.lastname: Yu
authors.affiliation: Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, Taiwan.
authors.forename: Henry Horng-Shing
authors.initials: HH
authors.lastname: Lu
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology*; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein
keywords: Barthel index; cerebral blood volume ratio; common carotid artery; modified Rankin scale; resistance index