Abstract 66: Predictors of Vascular Events or Death within One Year of Carotid Artery Stenting: Investigation on Devices and Anti-platelet Therapy for Carotid Artery Stenting (IDEALCAST)

Abstract

Background and Purpose: Carotid artery stenting (CAS) using distal filter protection device has been approved in April 2008 in Japan. However, factors affecting the development of vascular events and deaths after CAS have not been clarified in our country. The present study was conducted to identify the predictive factors for the development of vascular events or death after CAS. Methods: CAS was indicated for patients with at least one risk factor for carotid endarterectomy and with > 50 % stenosis in symptomatic or > 80% stenosis in asymptomatic carotid arteries. Between June 2008 and June 2010, we enrolled 949 patients who were planning to undergo elective CAS in 43 Japanese centers. Patients were followed at 30days and 12 months after stenting. The primary endpoint was the composite of death, any stroke, transient ischemic attack, myocardial infarction, and serious systemic bleeding. Results: Of the 934 patients (818 men, 72 ± 7 years old) followed for 1 year after stenting, primary endpoint was observed in 109 (11.7%) patients, including 18 (1.9%) deaths, 52 (5.6%) ischemic strokes, 7 (0.8%) hemorrhagic strokes, 16 (1.7%) transient ischemic attacks, 4 (0.4%) myocardial infarctions, and 11 (1.2%) serious systemic bleeding. In a multivariate proportional hazard model, older age (hazard ratio [HR], 1.24 per 5 years; 95% confidence interval [CI], 1.07 to 1.44; P=0.005), history of ischemic stroke (HR, 1.68; 95% CI, 1.10 to 2.62; P=0.015), combination of pre-procedural antiplatelet drugs (P=0.03), usage of diabetes drugs (HR, 1.93; 95% CI, 1.29 to 2.88, P=0.002), femoral artery puncture (HR,0.36; 95% CI 0.18 to 0.80; =0.015), use of guiding catheter system (HR, 1.69; 95% CI 1.08 to 2.71, P=0.021) and use of Angioguard XP in the procedure (HR, 1.92; 95% CI, 1.16 to 3.40, P=0.011) were associated with the development of vascular events or death. Conclusions: In addition to older age and medical history, selection of pre-procedural antiplatelet drugs and procedural devices can predict vascular events or death after CAS.