Abstract WP71: Real-world Outcomes After Carotid Artery Stenting

Carotid artery stenting (CAS) for carotid stenosis (CS) is widely performed. Randomized trials may not be reflective of real-world outcomes. We used the 2012-19 ACS-NSQIP CAS Procedure Targeted Dataset to identify the incidence and risk factors associated with periprocedural 30-day adverse events (AE). AE were categorized as follows: vascular (embolization - proximal and distal thrombosis, myocardial infarction [MI], stroke, restenosis, and TIA) , stroke/TIA alone, major (organ-space surgical site infection [SSI]), pneumonia, intubation, pulmonary embolism, post-operative ventilator use, blood transfusion, deep venous thrombosis, sepsis), minor (urinary tract infections, acute renal failure, superficial SSI). Other outcome variables were readmissions, reoperations, mortality, and non-home discharges. Multivariate logistic regression analysis, using backward stepwise model with entry and removal probabilities of p=0.05 and p=0.1. 1552 patients (median age=70 IQR 62-76) were included. 64% were male. 49% of CAS procedures were in asymptomatic patients, whereas 24% were following stroke, 16% to TIA and 8% for amaurosis fugax. 2.1% were mild (<50%) carotid stenosis, 26.6% were moderate (50%-79%) stenosis and 65.6% were severe (80%-99%) stenosis, while 2.7% were complete occlusions. Perioperative mortality was 1.9% and 10.6% were non-home discharges. 6.2% experienced vascular AE; 2.8% patients had perioperative strokes, 0.9% had TIA, 2.3% had MI, 0.7% had thrombosis, 0.4% had proximal embolization, 0.5% were restenosis, and 0.6% had distal embolization. Risks for major AE were COPD (OR 2.37; p=0.004), BUN>21 (OR 1.68; p=0.043), hypoalbuminemia (OR 3.00; p=0.002), and operative time >77mins (OR 1.92; p=0.013). Pre-procedural aspirin lowered odds of experiencing major AE (OR 0.43; p=0.035). Risk factors of 30-day readmissions were contralateral severe (OR 2.73; p=0.002) or complete (OR 3.07; p=0.001) stenosis, COPD (OR 2.01; p=0.003) and congestive heart failure (OR 2.85; p=0.004). In conclusion, almost half of CAS procedures were performed in asymptomatic patients. Periprocedural complications were higher than those reported in randomized trials. Physicians should use the findings for risk stratification.