Abstract TP196: Utility of CHADVASC2 Score in Predicting Clinical Outcomes of Patients Undergoing Carotid Angioplasty & Stent Placement

Abstract

Background: CHA2DS2-VASc score is used for stroke risk stratification in atrial fibrillation patients. We considered the possible use of the CHA2DS2Vasc score to predict perioperative stroke and subsequent stroke risk in patients undergoing CAS for symptomatic or asymptomatic atherosclerotic carotid disease. Methods: CAS Patients were identified from a prospectively collected neuroendovascular database maintained at our institution. We then collected the demographic information and the elements necessary to calculate the CHA2DS2vasc score. Primary outcomes were stroke within 30 days of the procedure and during follow-up. Mortality due to stroke and all-cause mortality were secondary outcomes. Patients were stratified into three groups based on their CHADVASC score. 0-3 (low risk), 4-6 (moderate risk) and 7-9 (high risk). We then compared the clinical outcomes amongst the three groups and high risk group was used as a reference during multivariate analysis. Results: From January 2010 to June 2018, 210 patients underwent CAS at our institution but after excluding patients with tandem lesions and radiation induced carotid stenosis,161 patients were included in the analysis [mean age 67 ± 25 years, 52 (32 %) were women]. Among the patients, 26 (16%) patients had CHA2DS2Vasc-score 0-3, 100 (62 %) in 4-6 group and 35 (22 %) in 7-9 group. A total of 10 (6.2%) had perioperative stroke and 4 (2.5 %) patients had perioperative death. Mean follow-up time was 17 months (range 0-96). Higher number perioperative strokes were observed in the patients with CHADVASC score 7-9 compared to moderate and low risk groups [(14% versus 3% versus 11.5 %) respectively; p-value 0.016]. Similarly recurrent stroke rate was significantly higher in high risk group compared to the other two [31.4% vs 4% vs 3.8% respectively); p-value <0.001]. After adjusting for age and gender, low risk patients (OR 0.011; p-value 0.03)] and moderate risk patients (OR 0.08, p-value 0.001)] had significantly less recurrent strokes when compared to high risk patients. Conclusion: In this analysis of CAS patients, higher CHA2DS2Vasc-Score predicted the increased perioperative and recurrent stroke risk. This should be validated further in large registries and trials of CAS patients.