Predictors of minor versus major stroke during carotid artery stenting: results from the carotid artery stenting (CAS) registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK).

BACKGROUND: Patient outcome, quality of life as well as health care costs differ between patients with minor versus major stroke during carotid artery stenting. Evaluation of predictors for both subtypes of strokes is of paramount importance. METHODS AND
RESULTS: We analyzed data from the prospective, web-based German carotid artery stenting (CAS) registry. All patients entered in this registry were included as of January 2011. During the periprocedural period (until patient discharge or transfer) 1.5 % of the patients (85/5,794) sustained a major and 1.3 % (75/5,784) a minor stroke (total periprocedural stroke rate 2.8 %). Mean age of all patients was 71 years, 72 % were male and 50 % had a symptomatic carotid stenosis. Regression analysis identified age (OR 1.44; 95 % CI 1.05-1.98), symptomatic stenosis (OR 3.17; 95 % CI 1.74-5.76) and procedural duration per 10 min (OR 1.22; 95 % CI 1.13-1.31) as independent predictors for major strokes. Age (OR 1.43; 95 % CI 1.03-1.98), diabetes (OR 1.75; 95 % CI 1.04-2.94), and procedural duration (OR 1.17; 95 % CI 1.08-1.27) predicted for minor strokes. The use of an embolic protection device significantly prevented both type of strokes (OR 0.31; 95 % CI 0.15-0.62 for major strokes; OR 0.40; 95 % CI 0.18-0.91 for minor strokes), female patients suffered less major strokes (OR 0.47; 95 % CI 0.24-0.92). Moreover, minor and major strokes were associated with death, contralateral embolism and a longer hospital stay more frequently.
CONCLUSION: Patients with one or more risk factors for periprocedural stroke seem to require special attention in terms of optimal preprocedural assessment of the carotid stenosis and vascular anatomy, as well as adequate patient preparation. Identifying these risk factors may help in patient selection, encourage further refinement in carotid artery stenting technique and avoid procedural complications. The use of an embolic protection device system was associated with less periprocedural minor and major strokes.