Thirty-Day CAS Results Published From the International Carotid Stenting Study

March 18, 2016—Findings on the effect of baseline patient demographic factors, processes of care, and technical factors during carotid artery stenting (CAS) on the risk of stroke, myocardial infarction (MI), or death within 30 days of CAS in the International Carotid Stenting Study (ICSS) were published by David Doig, MD, et al in the European Journal of Vascular and Endovascular Surgery (EJVES, 2016;51:327–334).

The investigators concluded that selection of patients for CAS should take symptoms, age, and side of the procedure into account. The results favor the use of closed-cell stents and also showed that cerebral protection devices did not protect against stroke.

In ICSS, suitable patients with recently symptomatic carotid stenosis > 50% were randomly allocated to CAS or endarterectomy. Factors influencing the risk of stroke, myocardial infarction, or death within 30 days of CAS were examined in a regression model for the 828 patients randomized to CAS in whom the procedure was initiated.

As summarized in EJVES, of the patients in ICSS, 7.4% suffered stroke, myocardial infarction, or death within 30 days of CAS. Independent predictors of risk were age, a right-sided procedure, aspirin and clopidogrel in combination before CAS, smoking status, and the severity of index event. In patients in whom a stent was deployed, use of an open-cell stent conferred higher risk than use of a closed-cell stent, reported the ICSS investigators in EJVES.