Abstract W P383: History of Transient Ischemic Attack Affects Outcome from Carotid Artery Stenting

Abstract

Objectives: Outcomes from carotid artery stenting (CAS) in a real world scenario is of interest to confirm clinical trial findings and to improve selection criteria. This prospective registry study intended to evaluate outcomes and predictors for adverse events of CAS. Methods: Patients received neurological and duplex exams before CAS, prior to discharge, and at 30 and 180 day follow-up. Multivariate regression analysis included patient-, lesion- and procedure-related characteristics. The major adverse cerebrovascular and cardiac events (MACCE) endpoint comprised stroke, myocardial infarction and death. Results: Three hundred seventy-five consecutive patients underwent CAS between 1998 and 2011. Mean age was 69 ±9.1 years, 53% were symptomatic within the preceding six months (20 minor and 40 major strokes, 140 ipsilateral transient ischemic attacks (TIA)). Mean time to CAS was shorter in patients with TIA compared to stroke, 23 versus 31 days ( P= 0.029). The MACCE rate was 1.6% during intervention and 4.0, 5.6 and 5.9% at discharge, at day 30 and 180. TIA occurred in 31 cases (9.6%) within 30 days. Multivariate regression analysis revealed that history of TIA was independently associated with MACCE (OR: 2.8; P =0.04), while prior stroke was not. Conclusions: TIA is a common and underappreciated adverse event following CAS. In addition, preprocedural TIA was an independent risk factor for adverse outcomes from CAS, while stroke was not, likely related to the timing of the procedure relative to the index event.