Comparison the effects of carotid endarterectomy with carotid artery stenting for contralateral carotid occlusion

Background There have been inconsistent results regarding the use of carotid artery endarterectomy (CEA) versus carotid artery stenting (CAS) for contralateral carotid occlusion (CCO). This study aimed to determine the optimal revascularization technique for patients with CCO. Methods We systematically searched the PubMed, Embase, and Cochrane Library databases to identify eligible studies published from inception to January 2, 2021. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to calculate pooled effect estimates using a random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed. Results Six studies involving 6,953 patients were selected for inclusion in this meta-analysis. Our results showed that while CEA was not associated with an increased risk of stroke compared to CAS (OR: 1.07; 95% CI: 0.75–1.51; P = 0.713), CEA was associated with a reduced risk of death compared to CAS (OR: 0.45; 95% CI: 0.29–0.70; P < 0.001). Furthermore, there were no significant differences between CEA and CAS for the risks of myocardial infarction (OR: 1.38; 95% CI: 0.73–2.62; P = 0.319) or major adverse cardiovascular events (OR: 1.03; 95% CI: 0.56–1.88; P = 0.926). Finally, the risk of myocardial infarction for CEA versus CAS was affected by disease status, while the risk of major adverse cardiovascular events was affected by the proportions of patients with male gender, coronary artery disease, and current or prior smoking. Conclusion This study found that CEA and CAS resulted in similar outcomes for patients with CCO, while the risk of death was reduced in patients treated with CEA. Further high-level evidence should be collected to verify the results of this study.

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Comparison of postoperative results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid artery occlusion: A meta-analysis

Vascular ◽

10.1177/1708538119841232 ◽

2019 ◽

Vol 27 (6) ◽

pp. 595-603 ◽

Cited By ~ 1

Author(s):

Wen-Qiang Xin ◽

Yan Zhao ◽

Tie-Zhu Ma ◽

Yi-Kuan Gao ◽

Wei-Han Wang ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Carotid Occlusion ◽

Cochrane Library ◽

Post Procedure ◽

Pubmed Database ◽

Significant Difference

Objectives The purpose of this study was to conduct a meta-analysis to systematically compare the safety and efficacy of carotid endarterectomy and carotid artery stenting in contralateral carotid occlusion patients who needed reperfusion. Methods This study retrieved potential academic articles comparing results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid occlusion from the MEDLINE database, the PubMed database the EMBASE database, and the Cochrane Library from January 1990 to May 2018. The reference articles for the identified studies were carefully reviewed to ensure that all available documents were represented in the study. Results Four retrospective cohort study involving 6252 patients with contralateral carotid occlusion were included in our meta-analysis. During 30-day follow-up, there is significant difference in post-procedure mortality (odds ratio (OR) = 0.476, 95% confidence interval (CI) (0.306–0.740), P = 0.001); no significant differences are not found in post-procedure stroke (risk difference (RD) = 0.002, 95%CI (–0.007 to 0.011); P = 0.631), myocardial infarction (RD = 0.003, 95%CI (–0.002 to 0.008); P = 0.301), and transient cerebral ischemia (RD = 1.059, 95%CI (–0.188 to 5.964); P = 0.948). Conclusions Carotid endarterectomy was associated with a lower incidence of mortality compared to carotid artery stenting for patients with contralateral carotid occlusion. Regarding stroke, myocardial infarction, and transient ischemic attack, there was no significant difference between the two groups. More randomized controlled trials and prospective cohorts are necessary to help further clarify the ideal approach for these patients.

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Comparison of In-hospital Major Adverse Cardiovascular Events in Patients of Acute Inferior Myocardial Infarction With or Without Precordial ST Segment Depression

Indonesian Journal of Cardiology ◽

10.30701/ijc.v37i4.582 ◽

2017 ◽

pp. 180-9

Author(s):

Jaya Suganti ◽

Abdullah Afif Siregar ◽

Harris Hasan

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Events ◽

Multiple Logistic Regression Analysis ◽

Major Adverse Cardiovascular Events ◽

Bivariate Analysis ◽

P Value ◽

Inferior Myocardial Infarction ◽

St Segment ◽

Increased Risk ◽

Acute Inferior Myocardial Infarction

Background: The clinical implications of precordial ST segment depression (PSTD) during acute inferior myocardial infarction has been an area of debate, and still under investigation with conflicting results. Based on previous studies, the presence of PSTD defines a high risk subset of patients with acute inferior myocardial infarction due to a more extensive myocardial ischemia that lead to a higher incidence of major adverse cardiovascular events (MACE). Despite of these results, others still considered this ECG finding as a benign electrical phenomenon. The aim of this study is to compare the incidence of in-hospital MACE in patients of acute inferior myocardial infarction with or without PSTD and to know whether PSTD can be used as a predictor of in-hospital MACE in acute inferior myocardial infarction.Methods: A total of 96 acute inferior myocardial infarction patients admitted from December 2013-2015 at Cardiology Department of Haji Adam Malik General Hospital were retrospectively analyzed. Patients were divided into two groups based on the presence of PSTD on admission ECG. Bivariate and multivariate analyses were performed to study the association between PSTD and in-hospital MACE, p value<0.05 was considered statistically significant.Results: The bivariate analysis showed that in-hospital MACE was significantly higher in patients of acute inferior myocardial infarction with PSTD than without PSTD (92% vs 8%, p<0.001). On multiple logistic regression analysis, patients of acute inferior myocardial infarction with PSTD have a 5.4 fold increased risk of in-hospital MACE than patients without PSTD (OR 5.480; 95% CI 1.759-17.067, p=0.003).Conclusion: The presence of precordial ST segment depression on admission ECG in acute inferior myocardial infarction patients was associated with a higher in-hospital MACE and was an independent predictor of in-hospital MACE.

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Combination Use of Clopidogrel and Proton Pump Inhibitors Increases Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248416663647 ◽

2016 ◽

Vol 22 (2) ◽

pp. 142-152 ◽

Cited By ~ 16

Author(s):

Qiang Niu ◽

Zhongsu Wang ◽

Yong Zhang ◽

Jiangrong Wang ◽

Pei Zhang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Combination Therapy ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Cardiovascular Events ◽

Cochrane Library ◽

Major Adverse Cardiovascular Events ◽

Increased Risk ◽

Artery Disease

Background: Published data indicated that combination use of clopidogrel and proton pump inhibitors (PPIs) may increase the incidence of major adverse cardiovascular events (MACEs). This has been a highly controversial topic for years. Design: The present study was performed to evaluate whether combination therapy of clopidogrel and PPIs is associated with increased risk of MACEs than with clopidogrel alone in patients with coronary artery disease. Methods: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted for studies recording the occurrence of MACEs in patients with exposure to concomitant use of clopidogrel and PPIs up to February 2015. Odds ratios (ORs) were combined using a random-effects model. Results: Patients receiving combination therapy with PPIs and clopidogrel were at significantly increased risk of MACEs (OR: 1.42; 95% confidence interval [CI]: 1.30-1.55). Adding a PPI to clopidogrel treatment was associated with a higher rate of MACE occurrence in rapid metabolizers (RMs, *1/*1) of CYP2C19 (OR: 1.42; 95% CI: 1.12-1.81), but there was no obviously increased rate (OR: 1.43; 95% CI: 0.89-2.28) in decreased metabolizers (with 1 or 2 loss-of-function allele). The increased risk of MACEs was similar in 4 classes of PPIs (omeprazole, lansoprazole, esomeprazole, and pantoprazole), but rabeprazole (OR: 1.03; 95% CI: 0.55-1.95) wasn’t. Conclusion: The combination use of clopidogrel and certain types of PPIs (omeprazole, lansoprazole, esomeprazole, pantoprazole) increases the risk of MACE in patients with coronary artery disease. Only in the RMs of CYP2C19, PPIs were associated with significantly increased MACE in patients coadministered with clopidogrel.

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Long-term outcome of patients with invasive electrophysiology procedure-related cardiac tamponade

EP Europace ◽

10.1093/europace/euaa155 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1547-1557

Author(s):

Gesa von Olshausen ◽

Tara Bourke ◽

Jonas Schwieler ◽

Nikola Drca ◽

Hamid Bastani ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Cardiac Tamponade ◽

Cardiovascular Events ◽

Control Group ◽

Risk Of Death ◽

Increased Risk

Abstract Aims Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analysed the risk of death or serious cardiovascular events in patients suffering from EP-related cardiac tamponade requiring pericardiocentesis during long-term follow-up. Methods and results Out of 19 997 invasive EPs at the Karolinska University Hospital between January 1998 and September 2018, all patients with EP-related periprocedural cardiac tamponade were identified (n = 60) and matched (1:3 ratio) to a control group (n = 180). After a follow-up of 5 years, the composite primary endpoint — death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure — occurred in significantly more patients in the tamponade than in the control group [12 patients (20.0%) vs. 19 patients (10.6%); hazard ratio (HR) 2.53 (95% confidence interval, CI 1.15–5.58); P = 0.021]. This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group [HR 3.75 (95% CI 1.01–13.97); P = 0.049]. Death from any cause, acute myocardial infarction, and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group [HR 36.0 (95% CI 4.68–276.86); P = 0.001]. Conclusion Patients with EP-related cardiac tamponade are at higher risk for cerebrovascular events during the first 2 weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.

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Prognostic Value of MicroRNAs in Patients after Myocardial Infarction: A Substudy of PRAGUE-18

Disease Markers ◽

10.1155/2019/2925019 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

M. Hromádka ◽

V. Černá ◽

M. Pešta ◽

A. Kučerová ◽

J. Jarkovský ◽

...

Keyword(s):

Myocardial Infarction ◽

Plasma Levels ◽

Troponin T ◽

Statistical Significance ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Major Adverse Cardiovascular Events ◽

Ventricular Ejection Fraction ◽

Risk Of Death ◽

Increased Risk

Background. The evaluation of the long-term risk of major adverse cardiovascular events and cardiac death in patients after acute myocardial infarction (AMI) is an established clinical process. Laboratory markers may significantly help with the risk stratification of these patients. Our objective was to find the relation of selected microRNAs to the standard markers of AMI and determine if these microRNAs can be used to identify patients at increased risk. Methods. Selected microRNAs (miR-1, miR-133a, and miR-499) were measured in a cohort of 122 patients from the PRAGUE-18 study (ticagrelor vs. prasugrel in AMI treated with primary percutaneous coronary intervention (pPCI)). The cohort was split into two subgroups: 116 patients who did not die (survivors) and 6 patients who died (nonsurvivors) during the 365-day period after AMI. Plasma levels of selected circulating miRNAs were then assessed in combination with high-sensitivity cardiac troponin T (hsTnT) and N-terminal probrain natriuretic peptide (NT-proBNP). Results. miR-1, miR-133a, and miR-499 correlated positively with NT-proBNP and hsTnT 24 hours after admission and negatively with left ventricular ejection fraction (LVEF). Both miR-1 and miR-133a positively correlated with hsTnT at admission. Median relative levels of all selected miRNAs were higher in the subgroup of nonsurvivors (N=6) in comparison with survivors (N=116), but the difference did not reach statistical significance. All patients in the nonsurvivor subgroup had miR-499 and NT-proBNP levels above the cut-off values (891.5 ng/L for NT-proBNP and 0.088 for miR-499), whereas in the survivor subgroup, only 28.4% of patients were above the cut-off values (p=0.001). Conclusions. Statistically significant correlation was found between miR-1, miR-133a, and miR-499 and hsTnT, NT-proBNP, and LVEF. In addition, this analysis suggests that plasma levels of circulating miR-499 could contribute to the identification of patients at increased risk of death during the first year after AMI, especially when combined with NT-proBNP levels.

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Association Between Circulating Proprotein Convertase Subtilisin/Kexin Type 9 and Major Adverse Cardiovascular Events, Stroke, and All-Cause Mortality: Systemic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.617249 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yimo Zhou ◽

Weiqi Chen ◽

Meng Lu ◽

Yongjun Wang

Keyword(s):

Dose Response ◽

Cardiovascular Events ◽

Meta Analysis ◽

Systemic Review ◽

Cochrane Library ◽

Major Adverse Cardiovascular Events ◽

Proprotein Convertase ◽

Standard Deviation Increase ◽

Increased Risk ◽

All Cause Mortality

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9), a pivotal protein in low-density lipoprotein cholesterol metabolism, has been validated to be an established target for cardiovascular (CV) risk reduction. Nevertheless, prospective studies concerning the associations between circulating PCSK9 and the risk of CV events and mortality have yielded, so far, inconsistent results. Herein, we conducted a meta-analysis to evaluate the association systemically.Methods: Pertinent studies were identified from PubMed, EMBASE, and Cochrane Library database through July 2020. Longitudinal studies investigating the value of circulating PCSK9 for predicting major adverse cardiovascular events (MACEs) or stroke or all-cause mortally with risk estimates and 95% confidence intervals (CI) were included in the analyses. Dose-response meta-analysis was also applied to evaluate circulating PCSK9 and risk of MACEs in this study.Results: A total of 22 eligible cohorts comprising 28,319 participants from 20 eligible articles were finally included in the study. The pooled relative risk (RR) of MACEs for one standard deviation increase in baseline PCSK9 was 1.120 (95% CI, 1.056–1.189). When categorizing subjects into tertiles, the pooled RR for the highest tertile of baseline PCSK9 was 1.252 (95% CI, 1.104–1.420) compared with the lowest category. This positive association between PCSK9 level and risk of MACEs persisted in sensitivity and most of the subgroup analyses. Twelve studies were included in dose-response meta-analysis, and a linear association between PCSK9 concentration and risk of MACEs was observed (x2 test for non-linearity = 0.31, P non-linearity = 0.575). No significant correlation was found either on stroke or all-cause mortality.Conclusion: This meta-analysis added further evidence that high circulating PCSK9 concentration significantly associated with increased risk of MACEs, and a linear dose-response association was observed. However, available data did not suggest significant association either on stroke or all-cause mortality. Additional well-designed studies are warranted to further investigate the correlations between PCSK9 concentration and stroke and mortality.

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Prasugrel or ticagrelor in patients with acute coronary syndrome and diabetes: a propensity matched substudy of RENAMI

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872618802783 ◽

2018 ◽

Vol 8 (6) ◽

pp. 536-542 ◽

Cited By ~ 6

Author(s):

Federico Conrotto ◽

Maurizio Bertaina ◽

Sergio Raposeiras-Roubin ◽

Tim Kinnaird ◽

Albert Ariza-Solé ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Propensity Score ◽

Propensity Score Matching ◽

Cardiovascular Events ◽

Major Adverse Cardiovascular Events ◽

Risk Of Death ◽

Coronary Syndrome ◽

Primary Endpoints ◽

Diabetes Patients

Introduction: The safety and efficacy of prasugrel and ticagrelor in patients with diabetes mellitus presenting with acute coronary syndrome and treated with percutaneous coronary intervention remain to be assessed. Methods: All diabetes patients admitted for acute coronary syndrome and enrolled in the REgistry of New Antiplatelets in patients with Myocardial Infarction (RENAMI) were compared before and after propensity score matching. Net adverse cardiovascular events (composite of death, stroke, myocardial infarction and BARC 3–5 bleedings) and major adverse cardiovascular events (composite of death, stroke and myocardial infarction) were the co-primary endpoints. Single components of primary endpoints were secondary endpoints. Results: Among 4424 patients enrolled in RENAMI, 462 and 862 diabetes patients treated with prasugrel and ticagrelor, respectively, were considered. After propensity score matching, 386 patients from each group were selected. At 19±5 months, major adverse cardiovascular events and net adverse cardiovascular events were similar in the prasugrel and ticagrelor groups (5.4% vs. 3.4%, P=0.16 and 6.7% vs. 4.1%, P=0.11, respectively). Ticagrelor was associated with a lower risk of death and BARC 2–5 bleeding when compared to prasugrel (2.8% vs. 0.8%, P=0.031 and 6.0% vs. 2.6%, P=0.02, respectively) and a clear but not significant trend for a reduction of BARC 3–5 bleeding (2.3% vs. 0.8%, P=0.08). There were no significant differences in myocardial infarction recurrence and stent thrombosis. Conclusion: Diabetes patients admitted for acute coronary syndrome seem to benefit equally in terms of major adverse cardiovascular events from ticagrelor or prasugrel use. Ticagrelor was associated with a significant reduction in all-cause death and bleedings, without differences in recurrent ischaemic events, which should be confirmed in dedicated randomised controlled trials.

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Measuring Heart Rate Variability in Patients Admitted with ST-Elevation Myocardial Infarction for the Prediction of Subsequent Cardiovascular Events: A Systematic Review

Medicina ◽

10.3390/medicina57101021 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1021

Author(s):

Crischentian Brinza ◽

Mariana Floria ◽

Adrian Covic ◽

Alexandru Burlacu

Keyword(s):

Myocardial Infarction ◽

Heart Rate ◽

Heart Rate Variability ◽

Cardiovascular Events ◽

St Elevation Myocardial Infarction ◽

Major Adverse Cardiovascular Events ◽

Prognostic Information ◽

Increased Risk ◽

All Cause Mortality ◽

St Elevation

Ischemic heart disease represents the leading cause of death, emphasizing risk stratification and early therapeutic intervention. Heart rate variability (HRV), an indirect marker of autonomic nervous system activity, was investigated extensively as a risk factor for adverse cardiovascular events following acute myocardial infarction. Thus, we systematically reviewed the literature to investigate the association of HRV parameters with mortality and adverse cardiovascular events in patients presenting with ST-elevation myocardial infarction (STEMI). Following the search process in the MEDLINE (PubMed), Embase, and Cochrane databases, nine studies were included in the final analysis. Lower time-domain HRV parameters and a higher ratio between power in the low-frequency (LF) band and power in the high-frequency (HF) band (LF/HF) were associated with higher all-cause mortality during follow-up, even in patients treated mainly with percutaneous coronary interventions (PCI). Although most studies measured HRV on 24 h ECG recordings, short- and ultra-short-term measures (1 min and 10 s, respectively) were also associated with an increased risk of all-cause mortality. Although data were discrepant, some studies found an association between HRV and cardiac mortality, reinfarction, and other major adverse cardiovascular events. In conclusion, HRV measurement in patients with STEMI could bring crucial prognostic information, as it was associated with an increased risk of all-cause mortality documented in clinical studies. More and larger clinical trials are required to validate these findings in contemporary patients with STEMI in the context of the new generation of drug-eluting stents and current antithrombotic and risk-modifying therapies.

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Serum Creatinine Concentration and the Risk of Stroke, Myocardial Infarction, and Vascular Death in Patients with Symptomatic Carotid Stenosis.

Stroke ◽

10.1161/str.32.suppl_1.365-a ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 365-365

Author(s):

Jose G Merino ◽

Michael Eliasziw ◽

J David Spence ◽

Henry Jm Barnett

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Serum Creatinine ◽

Large Artery ◽

Symptomatic Carotid ◽

Risk Of Death ◽

Vascular Death ◽

Symptomatic Carotid Stenosis ◽

Increased Risk ◽

History Of

P144 Background: High serum creatinine (SCr) is a predictor of mortality in patients with hypertension, myocardial infarction (MI), and stroke. In men it is associated with stroke. Objective: Examine the relationship between SCr and the risk of stroke, MI, and vascular death (VD) in patients with symptomatic internal carotid artery (ICA) stenosis. Methods: Data from 1977 male NASCET patients with baseline SCr measurements were analyzed. Results: Increased levels of SCr were associated with older age and a higher prevalence of hypertension, history of MI or angina, and intermittent claudication. No association was found between the level of SCr and a history of diabetes or hyperlipidemia or with the type and location of prior cerebrovascular ischemic events. The Kaplan-Meier risk for the outcomes of stroke at 5 years, MI at 5 years, and the combined outcome of stroke, MI, or VD at 5 years increased with increasing levels of SCr (all at a p< 0.001, table). This increased risk was unconfounded and remained statistically significant after adjusting for all baseline characteristics using Cox proportional hazards regression model. The causes of stroke were similar in all SCr level groups (70% large artery, 22% lacunar, 8% cardioembolic). The risk of death from any cause at 5 years increased with increased SCr levels, cardiac disorders were the predominant cause of death. Conclusion: A mild to moderate elevation of serum creatinine level is an independent risk factor for stroke, MI, and VD in male patients with recent ischemic symptoms attributable to carotid artery stenosis.

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High-Risk Factors in Symptomatic Patients Undergoing Carotid Artery Stenting With Distal Protection

Neurosurgery ◽

10.1227/neu.0000000000000871 ◽

2015 ◽

Vol 77 (4) ◽

pp. 531-543 ◽

Cited By ~ 10

Author(s):

Andrew A. Fanous ◽

Sabareesh K. Natarajan ◽

Patrick K. Jowdy ◽

Travis M. Dumont ◽

Maxim Mokin ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Carotid Artery ◽

Renal Disease ◽

Aortic Arch ◽

Carotid Artery Stenting ◽

Scoring System ◽

National Institutes Of Health ◽

Increased Risk ◽

Distal Protection

Abstract BACKGROUND: Demographics and vascular anatomy may play an important role in predicting periprocedural complications in symptomatic patients undergoing carotid artery stenting (CAS). OBJECTIVE: To predict factors associated with increased risk of complications in symptomatic patients undergoing CAS and to devise a CAS scoring system that predicts such complications in this patient population. METHODS: A retrospective study was conducted that included patients who underwent CAS for symptomatic carotid stenosis during a 3-year period. Demographics and anatomic characteristics were subsequently correlated with 30-day outcome measures. RESULTS: A total of 221 patients were included in the study. The cumulative rate of periprocedural complications was 7.2%, including stroke (3.2%), myocardial infarction (3.2%), and death (1.4%). Renal disease increased the risk of all complications. National Institutes of Health Stroke Scale score ≥10 at presentation, difficult femoral access, and diseased calcified aortic arch increased the risk of stroke and all complications. Type III aortic arch correlated with increased risk of stroke. Pseudo-occlusion and concentric calcification of the carotid artery increased the risk of myocardial infarction, death, and all complications. Carotid tortuosity and anatomy hostile to the deployment of distal protection devices increased the risk of stroke, myocardial infarction, death, and all complications. CONCLUSION: Our results suggest that CAS should be avoided in patients with multiple anatomic risk factors. High presenting National Institutes of Health Stroke Scale score and renal disease also increase the complication risk. The CAS scoring system devised here is simple, reproducible, and clinically valuable in predicting complications risk in symptomatic patients undergoing CAS.

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