Predictive Factors for Stroke and TIA Following Carotid Artery Stenting.

Autor:	Pérez-Sánchez S; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain.; Neurovascular Research Group, Biomedicine Institute of Seville, IBiS/Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain., Barragán Prieto A; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain.; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain., Gamero García MÁ; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain.; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain., Moniche F; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain.; Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Tomasello A; Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Hebron, Barcelona, Spain., Delgado-Acosta F; Interventional Neuroradiology, Department of Radiology, Hospital Reina Sofía, Córdoba, Spain., González A; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain.; Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain., Montaner J; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain.; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain.
Jazyk:	angličtina
Zdroj:	Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists [J Endovasc Ther] 2024 Oct; Vol. 31 (5), pp. 814-820. Date of Electronic Publication: 2023 Jan 07.
DOI:	10.1177/15266028221144586
Abstrakt:	Purpose: Carotid artery stenting (CAS) is an effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. The aim of the present study was to explore independent risk factors to predict cerebrovascular events following CAS to identify high-risk patients and improve the safety of CAS in this population. Materials and Methods: HISPANIAS is a national prospective multicenter study that included 14 hospitals that collected data from patients who underwent CAS. We analyzed morbidity and mortality within 30 days after CAS, looking for factors that might be associated with cerebrovascular events (stroke and transient ischemic attack [TIA]). Results: The HISPANIAS cohort included 757 patients: 80.32% were men, the mean age was 70.73 years, and 82.96% underwent symptomatic CAS. Cerebrovascular complications occurred in 42 patients (5.6%), including TIA in 24 patients (70.8% ipsilateral; mean 2.79 days after CAS) and stroke in 18 patients (72.2% ipsilateral; mean 6.72 days after CAS). The main independent clinical predictors of stroke/TIA identified by logistic regression were female sex (odds ratio [OR] 2.29, 95% CI 1.15-4.54) and diabetes (OR 3.29, 95% CI 1.71-6.40). Survival analysis showed that diabetic women, compared with the rest of the patients, had a higher number of events concentrated mainly in the first days after the intervention (p=0.003). Conclusion: Cerebrovascular ischemic complications after CAS continue to be a challenge for the management of these patients. Although there are other factors, female sex and the presence of diabetes are emerging as strong risk factors for the development of complications after symptomatic CAS. Clinical Impact: Carotid artery stenting (CAS) is an effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. Although CAS has been regarded as a reliable and safety approach, some studies reported that CAS was associated with a higher risk of procedure-related stroke. Cerebrovascular complications after CAS continue to be a main problem and a challenge for the management of these patients. Therefore, it is essential to identify the factors involved in the development of these complications. Our study shows that the combination of female sex and diabetes is associated with a clearly worse outcome, with a greater number of events concentrated mainly in the first days. This is different from other studies that have explored each factor separately. It would be interesting to perform separate interventions for this group given the increased risk of complications. Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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