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TIA may predict adverse outcomes after carotid stenting
In patients undergoing carotid artery stenting, transient ischemic attack is an “underappreciated adverse event,” researchers reported in a new study.
The prospective registry study included 375 consecutive patients who underwent carotid artery stenting (CAS) at University Heart Center Freiburg – Bad Krozingen, Germany, between 1998 and 2011. The researchers prospectively gathered data on pre- and postprocedural clinical assessment, duplex ultrasonography, angiography and neurological examination. These tests were conducted before CAS, before hospital discharge and at follow-up on day 30 ± 5 and day 180 ± 21.The researchers chronicled neurological events, which were classified as TIA, minor stroke or major stroke. MACCE were defined as the incidence of stroke, MI and death. Of the 375 patients who underwent CAS, 75% were male and the mean age was 69 ± 9.1 years.
A neurologic event preceding CAS was associated with the carotid stenosis in 53% of cases; these events consisted of 20 minor strokes, 40 major strokes and 89 TIAs. In patients who experienced a neurologic event up to 180 days before treatment, the mean time to treatment was 31 ± 30 days for stroke vs. 23 ± 28 days for TIA (P = .029). During CAS, the rate of MACCE was 1.6%. At discharge, the rate was 4%; at 30 days, 5.6%; and at 180 days, 5.9%. At day 30, 31 TIAs were documented (9.6%); of these, 17 occurred in symptomatic patients while 14 occurred in asymptomatic patients. Previous TIA was independently linked to MACCE (OR = 2.88; P = .04). Moreover, the combined endpoint of MACCE plus TIA was independently predicted by a history of hyperlipidemia (OR = 4.02; P = .029), MI (OR = 2.93; P = .007) and age at least 70 years (OR = 1.89; P = .033).
“This study is among the first to highlight the clinical importance of TIA in the context of CAS, recording an increased number of TIA, relating worse outcomes including TIA to high-risk patients and to the timing of CAS relative to the index event, and identifying a history of TIA as an underappreciated risk factor for the outcome after CAS besides a history of previous MI and hyperlipidemia,” the researchers wrote. “Our findings suggest selection criteria should be studied further within very large multicenter trials, addressing the timing of CAS after TIA relative to stroke to improve outcomes.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.