Carotid Lesion Length Independently Predicts Stroke and Death After Transcarotid Artery Revascularization and Transfemoral Carotid Artery Stenting

Abstract. Background: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. Patients and Methods: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. Results: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). Conclusions: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

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The Impact Of Carotid Lesion Calcification On Outcomes Of Carotid Artery Stenting

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.08.095 ◽

2021 ◽

Author(s):

Nadin Elsayed ◽

Kevin S. Yei ◽

Isaac Naazie ◽

Philip Goodney ◽

W. Darrin Clouse ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Lesion ◽

The Impact

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Angioplasty and carotid artery stenting: clinical and morphological factors affecting long-term outcomes

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2020-2470 ◽

2020 ◽

Vol 19 (3) ◽

pp. 2470

Author(s):

F. B. Shukurov ◽

E. S. Bulgakova ◽

B. A. Rudenko ◽

N. E. Gavrilova ◽

T. V. Tvorogova ◽

...

Keyword(s):

Carotid Artery ◽

Adverse Events ◽

Carotid Artery Stenting ◽

Lesion Length ◽

Open Cell ◽

Factors Affecting ◽

Residual Stenosis ◽

Stent Restenosis

Aim. To identify clinical and morphological factors affecting the longterm outcomes of endovascular angioplasty and carotid artery stenting.Material and methods. The analysis included 198 patients after carotid artery stenting between 03.2014 and 05.2018. There were following inclusion criteria: (1) 50% of symptomatic or 70% of asymptomatic carotid artery stenosis of according to NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria; (2) follow-up for each patient for at least 1 year. Using the univariate and multivariate logistic regression, risk factors associated with adverse events were determined.Results. The incidence of major adverse events during the 12-month follow-up was 9,6% (n=19), including 4 (2%) major and 6 (3%) minor strokes, 7 (3,5%) cases of transient ischemic attack; one (0,5%) patient had transient blindness and one (0,5%) died in the long-term follow-up period due to acute cerebrovascular accident in the target arterial territory. Also, 11 (5,6%) patients had restenosis >50% after 12-month follow-up. Multivariate analysis showed that long-term outcomes were significantly affected by: age >70 years (odds ratio (OR)=1,27, 95% confidence interval (CI): 1,07-1,61 (p=0,01); using of open-cell stents (OR=1,02, 95% CI: 1,01-1,03 (p=0,034)); contralateral stenosis (OR=1,28, 95% CI: 1,05-1,57 (p=0,01); lesion length >15 mm (OR=1,46, 95% CI: 1,12-1,89 (p=0,01)); residual stenosis <30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis ><30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02). Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >< 30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis <30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02).Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >15 mm, and residual stenosis < 30% may be associated with an increased risk of adverse events.

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