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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)

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Abstract

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.

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Fig. 1

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Abbreviations

CAS:

Carotid artery stenting

CEA:

Carotid endarterectomy

EPD:

Embolic protection device

GFR:

Glomerular filtration rate

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany

    Stephan Staubach, Ralph Hein-Rothweiler, Manuela Segerer & Harald Mudra

  2. Stiftung Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany

    Matthias Hochadel

  3. Herzzentrum Ludwigshafen, Ludwigshafen, Germany

    Ralf Zahn

  4. Medizinische Klinik I, Klinikum Worms, Worms, Germany

    Jens Jung

  5. Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum Bogenhausen, Munich, Germany

    Gotthard Rieß

  6. Medizinische Klinik 1, Leopoldina Krankenhaus, Schweinfurt, Germany

    Hubert Seggewiß

  7. Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Esslingen, Esslingen, Germany

    Andre Schneider

  8. Kardiologie und Angiologie, Klinikum Siloah, Hannover, Germany

    Thomas Fürste

  9. Klinik für Innere Medizin und Kardiologie, Marienhospital Osnabrück, Osnabrück, Germany

    Christian Gottkehaskamp

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  1. Stephan Staubach
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  2. Ralph Hein-Rothweiler
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  9. Andre Schneider
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  10. Thomas Fürste
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  11. Christian Gottkehaskamp
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  12. Harald Mudra
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Correspondence to Harald Mudra.

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Staubach, S., Hein-Rothweiler, R., Hochadel, M. et al. 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). Clin Res Cardiol 103, 345–351 (2014). https://doi.org/10.1007/s00392-013-0657-z

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  • DOI: https://doi.org/10.1007/s00392-013-0657-z

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