Courtney M. Daly, Cheong J. Lee, Melina Kibbe, Jason Chin, Mark Morasch, Heron Rodriguez, Mark K. Eskandari, Irene B. Helenowski
Vascular Surgery, Northwestern Memorial Hospital, Chicago, IL.
OBJECTIVES: To determine anatomic and plaque-related risk factors for patients undergoing carotid artery stenting.
METHODS: A retrospective review of patients in a prospectively maintained database undergoing carotid artery stenting at our institution between 2001-2010 was performed. Preoperative imaging studies (i.e., ultrasound, CTA, MRA and angiograms) were reviewed for specific anatomic criteria and plaque characteristics. Primary outcomes included perioperative neurologic events (30-day CVA or TIA), 30-day mortality, CVA and MI. Secondary outcome included stent restenosis.
RESULTS: Imaging was reviewed for 408 carotid arteries in 382 patients. There were 15 perioperative neurologic events (3.6%), with 8 TIA, 5 CVA and 2 seizures. Thirty-day mortality, CVA and MI was 0.5%, 2%, and 0.7%, respectively. Surprisingly, we found that arch type (I=32%, II=60%, III=7%), ostial involvement (12%), tandem lesions (20%) and plaque calcification (78%) did not correlate with perioperative neurologic events. Arch calcification was more common in female vs. male patients (mild 53.1% vs. 66.5%, moderate 32.3% vs. 26.5%, severe 14.6% vs. 7.1% p=0.05), but did not correlate with perioperative events. CCA tortuosity was more common in octogenarians (80% vs. 27.5% p=0.02), but did not correlate with perioperative events. Ipsilateral ECA stenosis >50% did correlate with perioperative neurologic events (8.2% vs. 2.3%, p=0.04). Plaque ulceration was present in 55% of patients and trended toward an increase in neurologic events (p=0.07). In terms of secondary criteria, a lower ICA to CCA angulation was associated with restenosis (p=0.03), and more steeply angulated arch types trended towards an increase in restenosis (I=1.1%, II=2.5%, III=10.5%, and p=0.09).
CONCLUSIONS: Our data suggest that ipsilateral ECA stenosis and plaque ulceration may be associated with increased perioperative neurologic risk during carotid stenting, but, surprisingly, arch type and calcification are not.
AUTHOR DISCLOSURES: J. Chin: Nothing to disclose; C. M. Daly: Nothing to disclose; M. K. Eskandari: Nothing to disclose; I. B. Helenowski: Nothing to disclose; M. Kibbe: Nothing to disclose; C. J. Lee: Nothing to disclose; M. Morasch: Nothing to disclose; H. Rodriguez: Nothing to disclose.
Posted April 2013