Outcomes of Carotid Artery Stenting in Elderly Patients: A Single Center Retrospective Study: the Effect of Post-dilatation on Outcomes

Abstract

Objective: Carotid artery stenting (CAS) is a current treatment approach that has been applied in symptomatic and asymptomatic carotid artery stenosis. In addition to being a minimally invasive method, it has fewer complications and mortality rates, and short hospital stays when compared to carotid endarterectomy. Some studies showed that the risk of stroke or death twice as high after CAS than after carotid endarterectomy among those ?70 years old. In this study, we aimed to investigate the short- and long-term complications, efficacy, and durability of CAS in elderly patients (?70 years old) with carotid artery stenosis with a median follow-up of 5.08 years (interquartile range 3.2-8.1), respectively. Material and Methods: A total of 140 patients who underwent CAS due to atherosclerotic carotid artery stenosis were included in the study. Stroke rates (total n=15[10.7%], n=3[5%] vs n=12[15%], p=0.049) were higher in patients who were ?70 years of age during the follow-up. The two groups (the group with age <70 and the group with age ?70) were compared according to demographic, biochemical data, and clinical outcomes such as stroke and stroke/death. Results: According to multivariate logistic regression analysis, those who were ?70 years, those with a history of earlier stroke, and the patients requiring post-dilatation were at risk of recurrent stroke. Deaths occurred in 5 of 140 patients in the follow-up. The patients who were ?70 years (OR 4.577 [95% CI=1.023-5.544], p=0.043), who have a history of earlier stroke (OR=6.965 [95% CI=1.067-13.115], p=0.038), and those requiring post-dilatation (OR=2.312 [95%CI=1.156-5.775], p=0.022) were at risk of recurrent stroke. Only age ?70 years (OR=4.577 [95% CI=1.210-17.191], p=0.024) was an important risk factor for death/stroke. Conclusion: Although the immediate results of the CAS procedure in patients with age ?70, were successful, they, especially in those with a history of earlier stroke and those requiring post-dilation, had a higher risk of stroke and the combined endpoint of death/stroke in the follow-up. Copyright © 2021 by Türkiye Klinikleri.