• Vascular Annual Meeting
• General Information
• Call for Abstracts
• Exhibitor Information
• Future Meeting Dates
• Past Meeting Information
• Contact Us

Effect Of Medical High Risk On Long-Term Survival And Stroke Following Carotid Artery Stenting

Theodore H Yuo¹, Philip P Goodney², Jack L. Cronenwett², Richard J. Powell^.2
1Dartmouth Medical School, Hanover, NH; ²Dartmouth-Hitchcock Medical Center, Lebanon, NH.

OBJECTIVES: The impact of medical high risk (MHR) on long-term survival and stroke after carotid artery stenting (CAS) has not been described, but this is important when considering MHR patients for CAS, especially if they are asymptomatic.

METHODS: 179 consecutive patients who underwent 196 CAS procedures for occlusive carotid bifurcation disease were classified by MHR status based on cardiac, pulmonary and renal criteria routinely used in clinical trials. Late survival and stroke rates were compared after 90 CAS procedures in MHR patients versus 106 CAS procedures in normal risk patients. Late survival results were also compared with 365 carotid endarterectomy (CEA) procedures in 346 patients.

RESULTS: The mean age of the CAS patients at the time of the procedure was 72 years old, with 87% having a smoking history, 85% hypertension, 38% diabetes, and 74% documented coronary artery disease. Mean CAS follow-up was 23 months; mean CEA follow-up was 19 months. Asymptomatic lesions were stented in 61%, while 39% were symptomatic. Recurrent stenosis after CEA comprised 21% of all procedures. During the 30-day post-procedure period, there were 5 minor strokes, 2 major strokes, and one death, for a combined stroke/death rate of 4%. Kaplan-Meier analysis demonstrated mortality of 5% at 1 year and 21% at 3 years for the entire cohort. Cox regression analysis found that, when compared to patients without MHR, MHR patients did not suffer increased mortality (Figure 1) or an increase in a composite end point of death or major or minor strokes. Age≥80 years old, LDL≥160 mg/dL, and serum creatinine≥1.5 mg/dL did confer statistically significant risk for both death and the composite end point of death or major or minor strokes (Table 1). Age-matching CEA and CAS patients revealed no statistically significant difference in mortality among all age cohorts.

CONCLUSIONS: The presence of MHR did not impact long-term survival or stroke rate after CAS, with overall survival comparable to outcomes after CEA. These results suggest the need for more refined predictors of medical risk to optimally select patients for treatment of carotid artery occlusive disease.