Registry Evaluates Outcomes and Predictors of Adverse Events After CAS

December 23, 2015—Findings from a prospective registry conducted to evaluate outcomes and predictors of adverse events following carotid artery stenting (CAS) were published by Roland R. Macharzina, MD, et al in EuroIntervention (2015;11:808–815).

In the registry, patients received neurologic and duplex exams before CAS, before discharge, and at 30- and 180-day follow-up. Multiple regression analysis included patient- and procedure-related characteristics. The major adverse cardiovascular or cerebrovascular events (MACCE) endpoint included stroke, myocardial infarction (MI), and death.

As summarized in EuroIntervention, 375 consecutive patients underwent CAS between 1998 and 2011. Mean age was 69 ± 9.1 years; 53% of patients were symptomatic within the preceding 6 months. Mean time to CAS was 23 days in patients with transient ischemic attack (TIA) and 31 days with stroke (P = .029). 

The investigators reported that the MACCE rate was 1.6% during intervention and 4%, 5.6%, and 5.9% at discharge, day 30, and day 180, respectively. TIA occurred in 31 (9.6%) patients within 30 days. A history of TIA was independently associated with MACCE (odds ratio [OR], 2.88; P = .04). Furthermore, a history of hyperlipidemia (OR, 4.02; P = .029), MI (OR, 2.93; P = .007), and age ≥ 70 years (OR, 1.89; P = .033) were independent predictors for the combined endpoint MACCE plus TIA.

TIA is an underappreciated adverse event following CAS. Preprocedural TIA was an independent risk factor for adverse outcomes and stroke was not, which was probably related to the timing of the procedure relative to the index event, concluded the investigators in EuroIntervention.