title: Factors affecting cardiovascular and cerebrovascular complications of carotid artery stenting in Northern Michigan: A retrospective study.
abstract: BACKGROUND
  This study seeks to identify factors associated with periprocedural complications of carotid artery stenting (CAS) to best understand CAS complication rates and optimize patient outcomes. Periprocedural complications include major adverse cardiovascular and cerebrovascular events (MACCE) that include myocardial infarction (MI), stroke, or death.
  
  
  METHODS
  We retrospectively analyzed 181 patients from Northern Michigan who underwent CAS. Rates of stroke, MI, and death occurring within 30days post-procedure were examined. Associations of open vs. closed cell stent type, demographics, comorbidities, and symptomatic carotid stenosis were compared to determine significance. All patients had three NIH Stroke Scale (NIHSS) exams: at baseline, 24h post-procedure, and at the one-month visit. Cardiac enzymes were measured twice in all patients, within 24h post-procedure. All patients were treated with dual anti-platelet therapy for at least 6months post-procedure.
  
  
  RESULTS
  Three patients (1.66%) experienced a major complication within one-month post-procedure. These complications included one MI (0.55%), one stroke (0.55%), and one death (0.55%). The following variable factors were not associated with the occurrence of MACCE complications within 30days post-procedure: stent design (open vs. closed cell) (p=1.000), age ≥80 (p=0.559), smoking history (p=0.569), hypertension (p=1.000), diabetes (p=1.000), and symptomatic carotid stenosis (p=0.254).
  
  
  CONCLUSIONS
  Age of 80years old or above, symptomatic carotid stenosis, open-cell stent design, and history of diabetes, smoking, or hypertension were not found to have an association with MACCE within 1month after CAS. Future studies using a greater sample size will be beneficial to better assess periprocedural complication risks of CAS, while also considering the effect of operator experience and technological advancements on decreasing periprocedural complication rates.
authors.affiliation: Central Michigan University College of Medicine, 1280 East Campus Drive, Mount Pleasant, MI 48859, USA. Electronic address: mammo1df@cmich.edu.
authors.forename: Dalia F
authors.initials: DF
authors.lastname: Mammo
authors.affiliation: Central Michigan University College of Medicine, 1280 East Campus Drive, Mount Pleasant, MI 48859, USA. Electronic address: cheng3c@cmich.edu.
authors.forename: Chin-I
authors.initials: CI
authors.lastname: Cheng
authors.affiliation: Central Michigan University College of Medicine, 1280 East Campus Drive, Mount Pleasant, MI 48859, USA. Electronic address: ragin1n@cmich.edu.
authors.forename: Neli P
authors.initials: NP
authors.lastname: Ragina
authors.affiliation: Central Michigan University College of Medicine, 1280 East Campus Drive, Mount Pleasant, MI 48859, USA; Covenant Cardiology, Covenant Healthcare System, 900 Cooper Ave, Saginaw, MI 48602, USA. Electronic address: Falani@chs-MI.com.
authors.forename: Firas
authors.initials: F
authors.lastname: Alani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications* / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000150:complications*; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Carotid artery stenting; MACCE; Periprocedural complications