From the Department of Medicine, Divisions of Cardiovascular Disease
(A.M., G.S.R., S.S.I., C.P., M.W.L., J.S.Y., H.D.C., L.S.D.) and Neurology
(C.R.G.), Department of Biostatistics (L.M.F.), and Department of Radiology
(J.J.V.), The University of Alabama at Birmingham.
Correspondence to Gary S. Roubin, MD, PhD, Lenox Hill Hospital, Black Hall, 130 E 77th St, New York, NY 10021-1803.
Background—The evolving technique of
carotid stenting is being evaluated as an alternative to
endarterectomy. Identification of the factors that
predispose a patient to neurological complications would facilitate
further refinement of the technique and optimize patient
selection.
Methods and Results—We analyzed the impact of various
clinical, morphological, and procedural determinants on the development
of procedural strokes in 231 patients who underwent elective (primary)
stenting of 271 extracranial carotid arteries. The mean age of the
patients was 68.7±10 years, 165 (71%) were males, and 139 (60%) had
symptoms attributed to the lesion treated. This series
represented a high-risk subset with 164 patients (71%)
having significant coronary artery disease, 91 (39%) having
bilateral disease, and 28 (12%) having contralateral carotid
occlusion. Of the treated vessels, 59 (22%) had prior carotid
endarterectomy, 66 (24%) had ulcerated plaques,
and 87 (32%) had calcified lesions. Only 37 treated vessels (14%)
would have been eligible for inclusion in the North American
Symptomatic Carotid Endarterectomy
Trial (NASCET). There were 17 (6.2%) minor and 2 (0.7%) major strokes
during and within 30 days of the procedure. NASCET-eligible patients
had a low (2.7%) risk of procedural strokes after carotid stenting.
The results of multivariate analysis revealed
advanced age (P=.006) and presence of long or multiple
stenoses (P=.006) as independent predictors of
procedural strokes.
Conclusions—During this procedural developmental phase of carotid
stenting, neurological complications were highly dependent on patient
selection. Advanced age and long or multiple stenoses were
independent predictors of procedural stroke.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Predictors of Stroke Complicating Carotid Artery Stenting
Key Words: stroke • carotid arteries • stents
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|
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|
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|
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|
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|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
A. M. Malek, R. T. Higashida, C. C. Phatouros, T. E. Lempert, P. M. Meyers, D. R. Gress, C. F. Dowd, and V. V. Halbach Treatment of Posterior Circulation Ischemia With Extracranial Percutaneous Balloon Angioplasty and Stent Placement Stroke, October 1, 1999; 30(10): 2073 - 2085. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Roubin Dear Editor-in-Chief: AJNR Am. J. Neuroradiol., August 1, 1998; 20(7): 1378 - 1381. [Full Text]
|
|
|
|
 |
|
 Predictors of Stroke Following Carotid Artery Stenting Journal Watch Cardiology, April 30, 1998; 1998(430): 13 - 13. [Full Text]
|
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