In-hospital and long-term outcomes in patients treated by carotid artery angioplasty

Introduction: Carotid artery stenting (CAS) has emer-ged as a safe and efficient alternative to surgical endar-terectomy in patients with carotid artery stenosis. Early recognition of risk factors and predictors of post-CAS complications could help further improving the outco-mes of these patients.
Objective: We aimed to identify the most relevant risk factors for the occurrence of post-CAS in-hospital and long-term complications.
Methods: All patients who underwent CAS at the Emergency Institute of Cardiovascular Diseases and Transplantation Tîrgu Mureș between 2010 and 2017 were enrolled in this study. Data regarding cardiovas-cular risk factors, hemodynamic and bio-clinical pro-file, and drug therapy were collected. Data concerning the CAS procedure were also noted. The ability of the-se factors to predict in-hospital and long-term post-CAS complications was evaluated. The patients were followed-up for a median of 19 (IQR 3-94) months.
Results: Of the 69 studied patients, 13 (18.8%) pre-sented in-hospital complications and 6 (9.8%) of the patients that were followed-up presented long-term complications. No in-hospital deaths were recorded; the long-term mortality rate was 6.6%. Occurrence of in-hospital stroke was positively correlated with the presence of chronic kidney disease (r=0.33, p<0.01) and negatively with the usage of antiplatelet therapy (r=-0.33, p<0.01). However, antiplatelet therapy was also associated with post-CAS intracranial hemorr-hage (r=0.33, p<0.01), whereas antiarrhythmic drugs usage was positively correlated with the occurrence of post-CAS bradycardia (r=0.28, p=0.01). Meanwhile, statins usage was associated with a lower risk of cere-bral hyperperfusion syndrome (r=-0.31, p<0.01). In-tra-procedural balloon dilation following protection filter positioning was associated with more post-pro-cedural complications (r=0.31, p=0.01). Over the long term, mortality rates were significantly correlated with the presence of heart failure (r=0.28, p=0.02) and atrial fibrillation (r=0.32, p=0.01), as well as with the usage of antiarrhythmic (r=0.46, p<0.01) and anticoagulant (r=0.32, p=0.01) therapy at discharge.
Conclusions: T he present study demonstrates that both in-hospital and long-term post-CAS outcomes can be significantly influenced by patients’ comorbi-dities, drug therapy, and procedural approach. Iden-tifying these factors prior to the CAS procedure and/or reducing the usage of balloon dilation following filter positioning could reduce the rates of post-CAS compli-cations and improve post-CAS survival. Funding:This work was supported by the University of Medicine and Pharmacy of Tîrgu Mureș Research Grant number 15609/6/29.12.2017.

ISSN
ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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The Romanian Journal of Cardiology is indexed by:
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CNCSIS B+
CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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This work is licensed under a Creative Commons Attribution 4.0 International License.