Carotid artery stenting in clinical practice depending on patient age

Catheter Cardiovasc Interv. 2017 Sep 1;90(3):451-460. doi: 10.1002/ccd.27127. Epub 2017 May 30.

Abstract

Background: The age-dependent outcome of carotid artery stenting (CAS) outside of randomized controlled trials is largely unknown. Therefore, we assessed acute and long-term results of CAS in a single-center real-world registry.

Methods: All symptomatic and asymptomatic patients who consecutively underwent CAS were enrolled into the present analysis. The population was divided into three groups dependent on patients' age (<65, 65-74, and ≥75 years).

Results: Between 1999 and 2015, a total of 878 patients (24%, <65 years; 40%, 65-74 years; and 36%, ≥75 years) underwent CAS. The rate of the primary endpoint (30-day composite of death, stroke, and myocardial infarction [MACCE] plus long-term ipsilateral stroke) was higher in patients aged ≥75 years compared to the middle-age group (hazard ratio [HR] 2.30, confidence interval [CI] 1.22-4.36; P = 0.001). Similarly, the rate of the stroke endpoint (30-day any stroke plus long-term ipsilateral stroke) was higher in patients aged ≥75 years compared to patients aged 65-74 years (HR 2.03, CI 1.01-4.10; P = 0.04). There was no significant age-dependent difference of the primary endpoint and stroke endpoint in the subset of asymptomatic patients. Furthermore, age had no influence on the risk of stroke beyond the periprocedural period.

Conclusions: Patients aged ≥75 years had poorer outcomes after CAS compared to younger patients. Importantly, age did not influence the outcome in asymptomatic patients and the risk for stroke beyond the periprocedural period.

Keywords: age; carotid artery stenting; long-term outcome; real world; stroke.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Aged
  • Asymptomatic Diseases
  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / mortality
  • Carotid Stenosis / therapy*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Endovascular Procedures / mortality
  • Humans
  • Kaplan-Meier Estimate
  • Middle Aged
  • Myocardial Infarction / etiology
  • Proportional Hazards Models
  • Recurrence
  • Registries
  • Risk Factors
  • Stents*
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome