Predictors of neurological events associated with carotid artery stenting in high-surgical-risk patients: insights from the Cordis Carotid Stent Collaborative

Circ Cardiovasc Interv. 2010 Dec;3(6):577-84. doi: 10.1161/CIRCINTERVENTIONS.110.950097. Epub 2010 Nov 23.


Background: Comorbid and anatomic characteristics that portend higher procedural risk are well defined for carotid endarterectomy but less so for carotid artery stenting.

Methods and results: We pooled carotid stent data from 4 Cordis-sponsored trials (n=2104) with similar patient cohorts and end point determination to identify predictors of neurological death or stroke within 30 days of the procedure. Median age was 74 years (24% >80 years), 36% were women, and 24.2% were symptomatic in the previous 6 months. There were 88 (4.2%) neurological deaths or strokes at 30 days. Among symptomatic patients, the risk of adverse neurological outcome declined with increasing time between the incident neurological event and carotid stent procedure. In a logistic regression model that included preprocedural and procedural variables, significant multivariable predictors of 30-day neurological death or stroke were older age (continuous), black race, angiographically visible thrombus in symptomatic patients, procedural use of glycoprotein IIb/IIIa inhibitors, procedural transient ischemic attack, final residual stenosis >30%, and periprocedural use of protamine or vasopressors.

Conclusions: In this pooled analysis, a number of preprocedural and procedural factors predicted higher risk of stroke and neurological death within 30 days of a carotid stent procedure. Identification of such predictors may help to guide patient selection and further refine procedural technique.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carotid Stenosis / therapy*
  • Clinical Trials as Topic
  • Female
  • Humans
  • Male
  • Multivariate Analysis
  • Risk
  • Stents* / adverse effects