Identification of patients at risk for periprocedural neurological deficits associated with carotid angioplasty and stenting

Background and Purpose-Transient or permanent neurological deficits can occ ur in the periprocedural period following carotid angioplasty and stenting (CAS), presumably due to distal embolization and/or hemodynamic compromise. We performed this study to identify predictors of neurological deficits as sociated with carotid angioplasty and stent placement. Methods-We reviewed medical records and angiograms in a consecutive series of patients who underwent CAS for symptomatic or asymptomatic cervical inte rnal carotid artery stenosis from June 1996 through December 1998. Using lo gistic regression analysis, we evaluated the effect of demographic, clinica l, intraprocedural, and angiographic risk factors on subsequent development of periprocedural neurological deficits. Periprocedural neurological defic its were defined as new or worsening transient or permanent neurological de ficits that occurred during or within 48 hours of the procedure. Results-A total of 111 patients (mean age 68.2 +/- 9.1 years) who underwent CAS for asymptomatic (n = 54) or symptomatic (n = 57) stenoses were includ ed in this study. A total of 13 periprocedural neurological deficits (13%) were observed either during (n = 4) or after (n = 10) the procedure. Three identified variables were independently associated with periprocedural neur ological deficits: symptomatic lesion (OR 8.3, 95% CI 1.6 to 42.6), length of stenotic segment greater than or equal to 11.2 mm (OR 5.2, 95% CI 1.2 to 22.5), and absence of hypercholesterolemia (OR 5.4, 95% CT 1.4 to 20.9). O ther variables, including age and degree of stenosis (defined by NASCET cri teria), were not associated with periprocedural neurological deficits. Conclusions-A combination of clinical and angiographic variables can be use d to identify patients at risk for periprocedural neurological deficits aft er GAS. Such identification may help in selection of patients who may benef it from novel pharmacological and mechanical preventive approaches.