Study Seeks Predictors of Neurological Events in High-Risk CAS Patients

November 23, 2010—The Cordis Carotid Stent Collaborative conducted a study that sought to define comorbid and anatomic characteristics that portend higher procedural risk for carotid artery stenting (CAS). The investigators noted these factors are well defined for carotid endarterectomy but less so for CAS. Herbert D. Aronow, MD, et al published the findings online ahead of print in Circulation: Cardiovascular Interventions.

In this pooled analysis, a number of preprocedural and procedural factors predicted a higher risk of stroke and neurological death within 30 days of a CAS procedure. Identification of such predictors may help to guide patient selection and further refine procedural technique, the investigators concluded.

According to the investigators, CAS data were pooled from four trials (N = 2,104) sponsored by Cordis Corporation (Bridgewater, NJ) with similar patient cohorts and endpoint determination to identify predictors of neurological death or stroke within 30 days of the procedure. Median age was 74 years (24% > 80 years), 36% were women, and 24.2% were symptomatic in the previous 6 months. There were 88 (4.2%) neurological deaths or strokes at 30 days.

The investigators found that among symptomatic patients, the risk of adverse neurological outcome declined with increasing time between the neurological event and the CAS procedure. In a logistic regression model that included preprocedural and procedural variables, significant multivariable predictors of 30-day neurological death or stroke were older age (continuous), black race, angiographically visible thrombus in symptomatic patients, procedural use of glycoprotein IIb/IIIa inhibitors, procedural transient ischemic attack, final residual stenosis > 30%, and periprocedural use of protamine or vasopressors, the investigators reported.