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)
| Autor: | Christian Gottkehaskamp, Stephan Staubach, Gotthard Rieß, Jens Jung, Matthias Hochadel, Thomas Fürste, Hubert Seggewiß, Ralf Zahn, Andre Schneider, Harald Mudra, Manuela Segerer, Ralph Hein-Rothweiler |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Severity of Illness Index Sex Factors Predictive Value of Tests Internal medicine Germany Severity of illness Confidence Intervals Odds Ratio Medicine Humans Carotid Stenosis cardiovascular diseases Hospital Mortality Prospective Studies Registries Prospective cohort study Survival rate Stroke Aged Ultrasonography Analysis of Variance business.industry Endovascular Procedures Age Factors General Medicine Odds ratio medicine.disease Survival Rate Stenosis Embolism Ischemic Attack Transient Predictive value of tests Multivariate Analysis Cardiology Female Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | Clinical research in cardiology : official journal of the German Cardiac Society. 103(5) |
| ISSN: | 1861-0692 |
| Popis: | 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. 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. 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. |
| Databáze: | OpenAIRE |
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