Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study

Eur J Vasc Endovasc Surg. 2016 Mar;51(3):327-34. doi: 10.1016/j.ejvs.2015.08.013. Epub 2015 Oct 24.


Objectives: Stroke, myocardial infarction (MI), and death are complications of carotid artery stenting (CAS). The effect of baseline patient demographic factors, processes of care, and technical factors during CAS on the risk of stroke, MI, or death within 30 days of CAS in the International Carotid Stenting Study (ICSS) were investigated.

Methods: In ICSS, suitable patients with recently symptomatic carotid stenosis > 50% were randomly allocated to CAS or endarterectomy. Factors influencing the risk of stroke, MI, or death within 30 days of CAS were examined in a regression model for the 828 patients randomized to CAS in whom the procedure was initiated.

Results: Of the patients, 7.4% suffered stroke, MI, or death within 30 days of CAS. Independent predictors of risk were age (risk ratio [RR] 1.17 per 5 years of age, 95% CI 1.01-1.37), a right-sided procedure (RR 0.54, 95% CI 0.32-0.91), aspirin and clopidogrel in combination prior to CAS (compared with any other antiplatelet regimen, RR 0.59, 95% CI 0.36-0.98), smoking status, and the severity of index event. In patients in whom a stent was deployed, use of an open-cell stent conferred higher risk than use of a closed-cell stent (RR 1.92, 95% CI 1.11-3.33). Cerebral protection device (CPD) use did not modify the risk.

Conclusions: Selection of patients for CAS should take into account symptoms, age, and side of the procedure. The results favour the use of closed-cell stents. CPDs in ICSS did not protect against stroke.

Keywords: Carotid artery stenosis; Carotid atherosclerosis; Myocardial infarction; Stents; Stroke.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carotid Artery, Common / surgery*
  • Carotid Stenosis / surgery*
  • Endarterectomy, Carotid / adverse effects
  • Endovascular Procedures / adverse effects*
  • Europe / epidemiology
  • Humans
  • Myocardial Infarction / etiology*
  • Myocardial Infarction / mortality
  • Postoperative Complications*
  • Risk Assessment
  • Risk Factors
  • Stents*
  • Stroke / etiology*
  • Stroke / mortality
  • Survival Rate / trends
  • Time Factors
  • Treatment Outcome

Associated data

  • ISRCTN/ISRCTN25337470