Incidence and risk factors for medical complications after carotid artery stenting

Objectives: The goal of this study was to determine the frequency and to identify potential clinical risk factors for the development of medical complications after carotid angioplasty and stenting (CAS).

Background: CAS is being evaluated as an alternative to carotid endarterectomy for the treatment of carotid artery stenosis, however, to date little is known about the incidence of medical complications after CAS.

Methods: Medical complications that occurred within 30 days after CAS in 327 consecutive patients (241 men, 86 women; mean age 69 „b 9 years, range 45–90 years) treated for symptomatic (n=182; 56%) or asymptomatic (n=145; 44%) carotid artery stenosis were recorded. The effect of clinical characteristics on the subsequent development of medical complications was analyzed by logistic regression.

Results: Fifty-one patients (15%) had 62 medical complications: 3 (0.9%) myocardial infarctions, 3 (0.9%) cardiac arrhythmias, 4 (1.2%) episodes of angina pectoris, 3 (0.9%) episodes of symptomatic hypertension, 16 (4.9%) episodes of symptomatic hypotension, 10 (3.1%) chest infections, 9 (2.7%) periods of confusion, 5 (1.5%) urinary retention and 9 (2.7%) urinary tract infections. Of the 62 medical complications one chest infection was fatal and 16 prolonged the intensive care unit monitoring period beyond 24 hours. Advanced age (OR, 1.1; 95% CI, 1.05 to 1.14) and the presence of a symptomatic carotid stenosis (OR, 2.1 95% CI, 1.07 to 4.1) independently predicted the occurrence of medical complications.

Conclusions: Although life-threatening or fatal nonneurological events were uncommon in this series, the overall incidence of medical complications after CAS might be higher than previously thought. Older and symptomatic patients are at highest risk so that these subgroups should be monitoring closely.