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(Stroke. 2008;39:2325.)
© 2008 American Heart Association, Inc.

Original Contributions

Predictors of Death and Stroke After Carotid Angioplasty and Stenting

A Subgroup Analysis of the Pro-CAS Data

Wolfram Theiss, MD; Peter Hermanek, MD; Klaus Mathias, MD; Hartmut Brückmann, MD; Jürgen Dembski, MD; Franz-Josef Hoffmann, MD; Rüdiger Kerner, MD; Franz Leisch, MD; Harald Mudra, MD; Karl-Ludwig Schulte, MD; Horst Sievert, MD for the German Society of Angiology/Vascular Medicine and the German Society of Radiology

From the Medizinische Klinik der Technischen Universität (W.T.), Munich, Germany; Bayerische Arbeitsgemeinschaft für Qualitätssicherung in der Stationären Versorgung (P.H.), Munich, Germany; the Institut für Strahlendiagnostik der Städtischen Kliniken (K.M.), Dortmund, Germany; Abteilung für Neuroradiologie (H.B.), Klinikum Grosshadern der Ludwig-Maximilians-Universität, Munich, Germany; Abteilung für Radiologie des Krankenhaus Marienhof (J.D.), Koblenz, Germany; Abteilung für Interventionelle Radiologie des Krankenhaus Neunkirchen (F.-J.H.), Germany; Abteilung Innere Medizin und Interventionelle Angiologie des Marienhospital (R.K.), Kevelaer, Germany; 1. Medizinische Abteilung des AÖ Krankenhaus (F.L.), Linz, Austria; Klinikum Neuperlach der Städtisches Klinikum München GmbH (H.M.), Munich, Germany; Vascular Center Berlin/Ev. Krankenhaus Königin Elisabeth Herzberge (K.-L.S.), Berlin, Germany; and the Cardiovascular Center (H.S.), Frankfurt, Germany.

Correspondence Wolfram Theiss, MD, Medizinische Klinik der Technischen Universität (W.T.), Heubergstr. 12, Munich D-81825, Germany. E-mail wolfram.theiss{at}gmx.d

Background and Purpose— Little is known about the significance of patient characteristics, clinical indications, and technical details on the risk of carotid angioplasty and stenting (CAS). The purpose of this study was to test these parameters as to their predictive value for the peri-interventional risk of CAS.

Methods— Pro-CAS is a prospective, multicenter registry of CAS. Logistic regression analysis of possible predictive factors was performed on 5341 interventions that had been entered by 25 clinical centers between July 1999 and June 2005.

Results— The combined in-hospital mortality and stroke rate was 3.6%. The following were found to be significant predictors of peri-interventional stroke and death: center experience (50 versus 51 to 150 versus 151 interventions), age, prior symptoms, primary intervention as compared with intervention for restenosis, angioplasty without stent, predilatation, and heparin dosage >5000 IU. No statistically significant result was found for year of intervention, patient volume, gender, interval between symptoms and CAS, ocular versus neurological symptoms, side of CAS, degree of stenosis of the target lesion, presence of contralateral high-degree stenosis or occlusion, method of gaining access to the carotids, stent type, and use of a protection system.

Conclusions— Our findings underline the need for dedicated training and strict credentialing rules for CAS. In addition, they might help to identify subgroups of patients at differential risk for CAS and carotid endarterectomy and yield a basis for correcting risks due to differences in case mix in reports about CAS.

Key Words: angioplasty and stenting • carotid stenosis • complications • outcome • registry

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