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(Stroke. 2000;31:376.)
© 2000 American Heart Association, Inc.

Original Contributions

Identification of Patients at Risk for Periprocedural Neurological Deficits Associated With Carotid Angioplasty and Stenting

Adnan I. Qureshi, MD; Andreas R. Luft, MD; Vallabh Janardhan, MD; M. Fareed K. Suri, MD; Mudit Sharma, BS; Giuseppe Lanzino, MD; Ajay K. Wakhloo, MD, PhD; Lee R. Guterman, PhD, MD L. Nelson Hopkins, MD

From the Department of Neurosurgery and Toshiba Stroke Research Center (A.I.Q., A.R.L., M.F.K.S., M.S., G.L., A.K.W., L.R.G., L.N.H.) and Department of Neurology (V.J.), School of Medicine and Biomedical Sciences, State University of New York at Buffalo, NY.

Correspondence to Adnan I. Qureshi, MD, SUNYAB Department of Neurosurgery, Millard Fillmore Hospital, 3 Gates Circle, Buffalo, NY 14209-1194. E-mail qureshi{at}acsu.buffalo.edu

Background and Purpose—Transient or permanent neurological deficits can occur in the periprocedural period following carotid angioplasty and stenting (CAS), presumably due to distal embolization and/or hemodynamic compromise. We performed this study to identify predictors of neurological deficits associated with carotid angioplasty and stent placement.

Methods—We reviewed medical records and angiograms in a consecutive series of patients who underwent CAS for symptomatic or asymptomatic cervical internal carotid artery stenosis from June 1996 through December 1998. Using logistic regression analysis, we evaluated the effect of demographic, clinical, intraprocedural, and angiographic risk factors on subsequent development of periprocedural neurological deficits. Periprocedural neurological deficits were defined as new or worsening transient or permanent neurological deficits that occurred during or within 48 hours of the procedure.

Results—A total of 111 patients (mean age 68.2±9.1 years) who underwent CAS for asymptomatic (n=54) or symptomatic (n=57) stenoses were included in this study. A total of 14 periprocedural neurological deficits (13%) were observed either during (n=4) or after (n=10) the procedure. Three identified variables were independently associated with periprocedural neurological deficits: symptomatic lesion (OR 8.3, 95% CI 1.6 to 42.6), length of stenotic segment 11.2 mm (OR 5.2, 95% CI 1.2 to 22.5), and absence of hypercholesterolemia (OR 5.4, 95% CI 1.4 to 20.9). Other variables, including age and degree of stenosis (defined by NASCET criteria), were not associated with periprocedural neurological deficits.

Conclusions—A combination of clinical and angiographic variables can be used to identify patients at risk for periprocedural neurological deficits after CAS. Such identification may help in selection of patients who may benefit from novel pharmacological and mechanical preventive approaches.

Key Words: angioplasty • carotid stenosis • cerebral ischemia, transient • stent • stroke

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