Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study.

Published

Journal Article

Stroke, myocardial infarction (MI), and death are complications of carotid artery stenting (CAS). The effect of baseline patient demographic factors, processes of care, and technical factors during CAS on the risk of stroke, MI, or death within 30 days of CAS in the International Carotid Stenting Study (ICSS) were investigated.In ICSS, suitable patients with recently symptomatic carotid stenosis > 50% were randomly allocated to CAS or endarterectomy. Factors influencing the risk of stroke, MI, or death within 30 days of CAS were examined in a regression model for the 828 patients randomized to CAS in whom the procedure was initiated.Of the patients, 7.4% suffered stroke, MI, or death within 30 days of CAS. Independent predictors of risk were age (risk ratio [RR] 1.17 per 5 years of age, 95% CI 1.01-1.37), a right-sided procedure (RR 0.54, 95% CI 0.32-0.91), aspirin and clopidogrel in combination prior to CAS (compared with any other antiplatelet regimen, RR 0.59, 95% CI 0.36-0.98), smoking status, and the severity of index event. In patients in whom a stent was deployed, use of an open-cell stent conferred higher risk than use of a closed-cell stent (RR 1.92, 95% CI 1.11-3.33). Cerebral protection device (CPD) use did not modify the risk.Selection of patients for CAS should take into account symptoms, age, and side of the procedure. The results favour the use of closed-cell stents. CPDs in ICSS did not protect against stroke.

Full Text

Duke Authors

Cited Authors

  • Doig, D; Turner, EL; Dobson, J; Featherstone, RL; Lo, RTH; Gaines, PA; Macdonald, S; Bonati, LH; Clifton, A; Brown, MM; ICSS Investigators,

Published Date

  • March 2016

Published In

Volume / Issue

  • 51 / 3

Start / End Page

  • 327 - 334

PubMed ID

  • 26602322

Pubmed Central ID

  • 26602322

Electronic International Standard Serial Number (EISSN)

  • 1532-2165

International Standard Serial Number (ISSN)

  • 1078-5884

Digital Object Identifier (DOI)

  • 10.1016/j.ejvs.2015.08.013

Language

  • eng