Abstract 1963: Elevated Anticardiolipin Antibodies are an Independent Risk Factor for Neurological Complications in Carotid Stenting
Background and Purpose - Carotid stenting (CS) has become a therapeutic alternative to endarterectomy in the treatment of high-grade internal carotid artery stenosis. Despite the development of cerebral protection devices periinterventional thromboembolism and consecutive neurological deficit (PND) remain the major risk factor for the procedure. Next to previously identified risk factors we prospectively studied the potential role of thrombophilic conditions in patients undergoing CS.
Methods - Anticardiolipin antibodies (ACL, IgG isotype), antithrombin III, and protein C and S levels were quantitated in patients with high-grade (> 70%) carotid artery stenosis before CS. In addition, activated protein C resistance (APC-R) was measured followed by factor V Leiden mutation analysis in patients with low APC-R ratio. Occurence of periprocedural neurological deficit within 48 hours after the procedure was recorded. Logistic regression analysis was performed to test for the influence of thrombophilic conditions, demographic factors and lesion characteristics on PND.
Results - A total of 232 patients with symptomatic (n = 59) or asymptomatic (n = 173) cerebrovascular disease, who underwent unprotected (n = 135) or protected (n = 95) CS, were included in the study. PND occured in 19 patients (8.2%) with a similar cardiovascular risk profile compared to the non-PND group. In 4 (36%) out of 11 patients with with elevated ACL (> 15 Units/ml) neurological ischemic complications were observed. Two identified variables were independently associated with PND: lesion length > 11.2mm (OR 6.3, 95% CI 1.3 to 30) and heightened ACL (OR 7.1, 95% CI 1.5–32.4).
Conclusion - A thrombophilic condition due to elevation of anticardiolipin antibodies increases the risk of periinterventional neurological complications during CS. In addition, we confirm previous data on higher PND risk dependent on lesion length.