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

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...

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Autores principales: Doig, D., Turner, E.L., Dobson, J., Featherstone, R.L., Lo, R.T.H., Gaines, P.A., Macdonald, S., Bonati, L.H., Clifton, A., Brown, M.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786052/
https://www.ncbi.nlm.nih.gov/pubmed/26602322
http://dx.doi.org/10.1016/j.ejvs.2015.08.013
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author Doig, D.
Turner, E.L.
Dobson, J.
Featherstone, R.L.
Lo, R.T.H.
Gaines, P.A.
Macdonald, S.
Bonati, L.H.
Clifton, A.
Brown, M.M.
author_facet Doig, D.
Turner, E.L.
Dobson, J.
Featherstone, R.L.
Lo, R.T.H.
Gaines, P.A.
Macdonald, S.
Bonati, L.H.
Clifton, A.
Brown, M.M.
author_sort Doig, D.
collection PubMed
description 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.
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spelling pubmed-47860522016-03-22 Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study Doig, D. Turner, E.L. Dobson, J. Featherstone, R.L. Lo, R.T.H. Gaines, P.A. Macdonald, S. Bonati, L.H. Clifton, A. Brown, M.M. Eur J Vasc Endovasc Surg Article 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. Elsevier 2016-03 /pmc/articles/PMC4786052/ /pubmed/26602322 http://dx.doi.org/10.1016/j.ejvs.2015.08.013 Text en © 2015 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Doig, D.
Turner, E.L.
Dobson, J.
Featherstone, R.L.
Lo, R.T.H.
Gaines, P.A.
Macdonald, S.
Bonati, L.H.
Clifton, A.
Brown, M.M.
Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study
title Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study
title_full Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study
title_fullStr Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study
title_full_unstemmed Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study
title_short Predictors of Stroke, Myocardial Infarction or Death within 30 Days of Carotid Artery Stenting: Results from the International Carotid Stenting Study
title_sort predictors of stroke, myocardial infarction or death within 30 days of carotid artery stenting: results from the international carotid stenting study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786052/
https://www.ncbi.nlm.nih.gov/pubmed/26602322
http://dx.doi.org/10.1016/j.ejvs.2015.08.013
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