Abstract 14363: The Impact of Timing on Carotid Artery Stenting in the Symptomatic Population
Background: The optimal timing of carotid artery stenting (CAS) after transient ischemic attack (TIA) or stroke (CVA) is unknown. Analysis of carotid endarterectomy trials suggests that surgical intervention within 14 days from the neurologic event is associated with improved outcomes. The ACC/SCAI/SVMB/SIR/ASITN 2007 consensus document on CAS provides limited information on the optimal timing of CAS. Therefore, we utilized NCDR® CARE Registry® data to evaluate the outcome of early CAS (≤30 days) post ipsilateral TIA or CVA compared with CAS >30 days. Our primary endpoint was the composite of TIA, CVA, MI or neurologic death at 30 days. Our secondary endpoint was the composite of in-hospital TIA, CVA, MI or neurologic death.
Methods: Retrospective evaluation of symptomatic patients (ipsilateral TIA or CVA) undergoing CAS between 1/2005 and 2/2011 included in the NCDR-CARE registry was performed. Baseline characteristics, procedural, in-hospital and 30-day events (TIA, CVA, MI, and neurologic death) were compared between those undergoing CAS at <30 days and >30 days. Comparisons of continuous variables were performed using a Student's t-test, and categorical variables by Chi square tests. To account for possible confounders we performed multivariable adjusted analysis by deriving and adjusting a propensity score predicting <30 days.
Results: There were 899 patients who met criteria, of which 614 underwent CAS at <30 days and 285 underwent CAS >30 days. Patients in both groups were evenly matched with respect to demographics except for a higher incidence of dyslipidemia, smoking, COPD and angina class III/IV in the >30 day group and hemodialysis in the <30 day group. The group undergoing CAS > 30 days was more likely to be on clopidogrel prior to intervention. There were no significant differences in the composite endpoints of TIA, CVA, MI or neurologic death at 30 days between the 2 groups. (7.3% vs. 4.6%, p=0.116). Likewise, there were no significant differences with respect to the composite of in-hospital TIA, CVA, MI or neurologic death between the 2 groups (5.4% vs. 3.2%, p=0.143).
Conclusion: These data suggest that the optimal timing of CAS in symptomatic patients can be individualized and performed safely at any time interval following a neurologic event.
- © 2011 by American Heart Association, Inc.