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(Stroke. 2006;37:2557.)
© 2006 American Heart Association, Inc.

Original Contributions

Risk Score for Peri-Interventional Complications of Carotid Artery Stenting

Robert Hofmann, MD; Alexander Niessner, MD; Alexander Kypta, MD; Clemens Steinwender, MD; Jürgen Kammler, MD; Klaus Kerschner, MD; Michael Grund, MD; Franz Leisch, MD Kurt Huber, MD

From the Cardiovascular Division (R.H., A.K., C.S., J.K., K.K., M.G., F.L.), City Hospital Linz, Austria; the Medical University of Vienna (A.N.), Austria; and the Wilhelminenhospital Vienna (K.H.), Austria.

Correspondence to Dr Robert Hofmann, Cardiovascular Division, City Hospital Linz, Austria, A-4020 Linz, Krankenhausstr. 9. E-mail robert.hofmann{at}akh.linz.at

Background and Purpose— Routinely available independent risk factors for the peri-interventional outcome of patients undergoing elective carotid artery stenting (CAS) are lacking. The rationale of the study was to create a risk score identifying high-risk patients.

Methods— We prospectively enrolled 606 consecutive patients assigned to CAS at a secondary care hospital. Various biochemical, clinical, and lesion-related risk factors were prospectively defined. The primary end point reflecting periprocedural complications encompassed minor and major stroke, nonfatal myocardial infarction and all-cause mortality within 30 days.

Results— Three percent of patients (n=18) experienced a nonfatal minor (n=13) or major (n=5) stroke. 1.3% of patients (n=8) died from fatal stroke (n=4) or other causes (n=4). No myocardial infarction was observed within 30 days after stenting. Multivariable analysis revealed diabetes mellitus with inadequate glycemic control (HbA_1c >7%), age 80 years, ulceration of the carotid artery stenosis, and a contralateral stenosis 50% as independent risk factors. A risk score formed with these variables showed a superior predictive value (C-statistic=0.73) compared with single risk factors. The presence of 2 or more of these risk factors identified patients with a risk of 11% for a periprocedural complication compared with 2% in patients with a score of 0 or 1.

Conclusions— In patients undergoing elective CAS, a risk score based on routinely accessible variables was able to identify patients at high-risk for atherothrombotic events and all-cause death within 30 days after the intervention.

Key Words: carotid stenosis • complications • risk factors

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