Clinical Predictors of Transient Ischemic Attack, Stroke, or Death within 30 Days of Carotid Artery Stent Placement with Distal Balloon Protection

Received 25 October 2007; received in revised form 5 October 2008; accepted 6 October 2008. published online 17 November 2008.

Purpose

Carotid artery stent placement has been accepted as an effective alternative to carotid endarterectomy (CEA), especially in patients at high risk in the setting of CEA. The purpose of this study was to determine potential clinical risk factors for the development of postprocedural neurologic deficits after carotid artery stent placement.

Materials and Methods

The clinical characteristics of 58 patients (49 men, nine women; 41 at high risk with CEA, 17 at low risk; median age, 70 years) who underwent carotid artery stent placement with distal balloon protection for 65 hemispheres/arteries (31 asymptomatic lesions and 34 symptomatic lesions) and the combined 30-day complication rates (transient ischemic attack [TIA], minor stroke, major stroke, or death) were analyzed.

Results

Six patients (9.0%) experienced a TIA and one patient (1.5%) had a major stroke (1.5%) within 30 days of the procedure. There were no deaths, so the overall 30-day combined stroke and death rate was 1.5%. The χ2 test revealed that advanced age (>75 years) was a significant clinical predictor of 30-day combined neurologic complications and major adverse effects (P < .01). In addition, a symptomatic lesion was marginally associated with the 30-day incidence of neurologic ischemia on the ipsilateral side (P = .049).

Conclusions

Our data suggest that carotid artery stent placement with distal balloon protection can be performed with similar periprocedural complication rates as CEA. CEA should be the first-line treatment in the management of patients older than 75 years of age.

Abbreviations: CEA, carotid endarterectomy, EPD, embolic protection device, NASCET, North American Symptomatic Carotid Endarterectomy Trial, TIA, transient ischemic attack

a Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka, Japan

b Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan

c Department of Neurosurgery, Nagasaki University Hospital, Nagasaki, Japan

Address correspondence to N.S., Department of Neurosurgery, Kobe City Medical Center General Hospital, 4-6 Minatojimanaka-machi, Chuo-ku, Kobe 650-0046, Japan

None of the authors have identified a conflict of interest.

PII: S1051-0443(08)00902-0

doi:10.1016/j.jvir.2008.10.008

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