Carotid Artery Stenting: Identification of Risk Factors for Poor Outcomes

Objectives: Age greater than 80 has been identified as a risk factor for complications, including stroke and death, in patients undergoing carotid artery angioplasty and stenting (CAS). This study evaluates other potential predictors of perioperative complications in patients undergoing CAS.
Methods: All cerebrovascular endovascular procedures performed by the vascular surgery division at our university hospital between July 2003 and December 2005 were retrospectively examined. During the course of 212 admissions, 198 patients underwent 215 procedures. Patient age, comorbidities, and admission status were analyzed as independent (predictor) variables. Complication rate, discharge disposition, and length of hospital stay were considered dependent (outcome) variables. Logistic regression and Fischer’s exact test or Student’s t-test were performed, as appropriate.
Results: Complications included major and minor stroke, myocardial infarction, femoral artery pseudoaneurysm, and death. The rates of perioperative major and minor stroke were 0.5% and 2.8%, respectively. Chronic renal insufficiency was a predictor of perioperative complications, including stroke: patients with serum creatinine greater than 1.3 mg/dL had a 37% complication rate and a 12% stroke rate, while those with normal renal function had a 13% complication rate (p=.003) and a 0.6% stroke rate (p=.002). Emergency admission predicted both extended hospital stay (p<.001) and requirement for further inpatient care in a rehabilitation or nursing facility (p=.007). There was no significant difference in complication rate or stroke rate between octogenarians and others.
Conclusions: This experience demonstrates that chronic renal insufficiency and emergent clinical setting are risk factors for patients undergoing CAS.