Carotid artery stenting in octogenarians: Periprocedural stroke risk predictor analysis from the multicenter carotid acculink/accunet post approval trial to uncover rare events (capture 2) clinical trial

Seemant Chaturvedi, Jon S. Matsumura, William Gray, Chuanbo Xu, Patrick Verta

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-: Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) is an ongoing prospective, nonrandomized, multicenter clinical trial enrolling patients undergoing carotid artery stenting. The aim of this analysis is to identify risk predictors for periprocedural stroke in patients ≥80 years old. METHODS-: Symptomatic patients with ≥50% stenosis and asymptomatic patients with ≥80% stenosis were enrolled. Patients' neurological status was assessed by an independent neurologist before as well as 24 hours and 30 days postprocedure. All strokes and suspected strokes were adjudicated by an independent committee. Logistic regression analysis was conducted to identify baseline demographic, lesion, procedural, or comorbidity parameters associated with outcomes in patients ≥80 years of age. RESULTS-: As of January 10, 2009, 5297 patients underwent carotid artery stenting in 186 US CAPTURE 2 clinical centers and 1166 were ≥80 years old. Octogenarians were similar to nonoctogenarians in terms of gender and symptomatic status but had fewer of certain risk factors (prior myocardial infarction or carotid endarterectomy, diabetes, smoking history) and more cardiac arrhythmia and renal insufficiency. For the overall cohort, death/stroke rate was 3.3%; stroke rate was 2.7% (0.8% major, 1.9% minor). Death/stroke rates were significantly higher for octogenarians than nonoctogenarians (4.5% versus 3.0%) as were stroke rates (3.8% versus 2.4%). Symptomatic status, embolic protection device dwell time, and lesion length were risk predictors for periprocedural stroke in octogenarians. CONCLUSIONS-: Patients ≥80 years old have higher periprocedural event rates than nonoctogenarians. Age, symptomatic status, and lesion length should be considered when identifying appropriate candidates for the procedure.

Original languageEnglish (US)
Pages (from-to)757-764
Number of pages8
JournalStroke
Volume41
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Carotid Arteries
Stroke
Clinical Trials
Pathologic Constriction
Embolic Protection Devices
Mortality
Carotid Endarterectomy
Multicenter Studies
Renal Insufficiency
Comorbidity
Cardiac Arrhythmias
Logistic Models
Smoking
History
Myocardial Infarction
Regression Analysis
Demography

Keywords

  • Carotid artery stenting
  • Octogenarians
  • Outcome
  • Risk predictors
  • Stenosis
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Carotid artery stenting in octogenarians : Periprocedural stroke risk predictor analysis from the multicenter carotid acculink/accunet post approval trial to uncover rare events (capture 2) clinical trial. / Chaturvedi, Seemant; Matsumura, Jon S.; Gray, William; Xu, Chuanbo; Verta, Patrick.

In: Stroke, Vol. 41, No. 4, 04.2010, p. 757-764.

Research output: Contribution to journalArticle

@article{7723a860cd064d15b0577c945e2d2f2b,
title = "Carotid artery stenting in octogenarians: Periprocedural stroke risk predictor analysis from the multicenter carotid acculink/accunet post approval trial to uncover rare events (capture 2) clinical trial",
abstract = "BACKGROUND AND PURPOSE-: Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) is an ongoing prospective, nonrandomized, multicenter clinical trial enrolling patients undergoing carotid artery stenting. The aim of this analysis is to identify risk predictors for periprocedural stroke in patients ≥80 years old. METHODS-: Symptomatic patients with ≥50{\%} stenosis and asymptomatic patients with ≥80{\%} stenosis were enrolled. Patients' neurological status was assessed by an independent neurologist before as well as 24 hours and 30 days postprocedure. All strokes and suspected strokes were adjudicated by an independent committee. Logistic regression analysis was conducted to identify baseline demographic, lesion, procedural, or comorbidity parameters associated with outcomes in patients ≥80 years of age. RESULTS-: As of January 10, 2009, 5297 patients underwent carotid artery stenting in 186 US CAPTURE 2 clinical centers and 1166 were ≥80 years old. Octogenarians were similar to nonoctogenarians in terms of gender and symptomatic status but had fewer of certain risk factors (prior myocardial infarction or carotid endarterectomy, diabetes, smoking history) and more cardiac arrhythmia and renal insufficiency. For the overall cohort, death/stroke rate was 3.3{\%}; stroke rate was 2.7{\%} (0.8{\%} major, 1.9{\%} minor). Death/stroke rates were significantly higher for octogenarians than nonoctogenarians (4.5{\%} versus 3.0{\%}) as were stroke rates (3.8{\%} versus 2.4{\%}). Symptomatic status, embolic protection device dwell time, and lesion length were risk predictors for periprocedural stroke in octogenarians. CONCLUSIONS-: Patients ≥80 years old have higher periprocedural event rates than nonoctogenarians. Age, symptomatic status, and lesion length should be considered when identifying appropriate candidates for the procedure.",
keywords = "Carotid artery stenting, Octogenarians, Outcome, Risk predictors, Stenosis, Stroke",
author = "Seemant Chaturvedi and Matsumura, {Jon S.} and William Gray and Chuanbo Xu and Patrick Verta",
year = "2010",
month = "4",
doi = "10.1161/STROKEAHA.109.569426",
language = "English (US)",
volume = "41",
pages = "757--764",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Carotid artery stenting in octogenarians

T2 - Periprocedural stroke risk predictor analysis from the multicenter carotid acculink/accunet post approval trial to uncover rare events (capture 2) clinical trial

AU - Chaturvedi, Seemant

AU - Matsumura, Jon S.

AU - Gray, William

AU - Xu, Chuanbo

AU - Verta, Patrick

PY - 2010/4

Y1 - 2010/4

N2 - BACKGROUND AND PURPOSE-: Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) is an ongoing prospective, nonrandomized, multicenter clinical trial enrolling patients undergoing carotid artery stenting. The aim of this analysis is to identify risk predictors for periprocedural stroke in patients ≥80 years old. METHODS-: Symptomatic patients with ≥50% stenosis and asymptomatic patients with ≥80% stenosis were enrolled. Patients' neurological status was assessed by an independent neurologist before as well as 24 hours and 30 days postprocedure. All strokes and suspected strokes were adjudicated by an independent committee. Logistic regression analysis was conducted to identify baseline demographic, lesion, procedural, or comorbidity parameters associated with outcomes in patients ≥80 years of age. RESULTS-: As of January 10, 2009, 5297 patients underwent carotid artery stenting in 186 US CAPTURE 2 clinical centers and 1166 were ≥80 years old. Octogenarians were similar to nonoctogenarians in terms of gender and symptomatic status but had fewer of certain risk factors (prior myocardial infarction or carotid endarterectomy, diabetes, smoking history) and more cardiac arrhythmia and renal insufficiency. For the overall cohort, death/stroke rate was 3.3%; stroke rate was 2.7% (0.8% major, 1.9% minor). Death/stroke rates were significantly higher for octogenarians than nonoctogenarians (4.5% versus 3.0%) as were stroke rates (3.8% versus 2.4%). Symptomatic status, embolic protection device dwell time, and lesion length were risk predictors for periprocedural stroke in octogenarians. CONCLUSIONS-: Patients ≥80 years old have higher periprocedural event rates than nonoctogenarians. Age, symptomatic status, and lesion length should be considered when identifying appropriate candidates for the procedure.

AB - BACKGROUND AND PURPOSE-: Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events (CAPTURE 2) is an ongoing prospective, nonrandomized, multicenter clinical trial enrolling patients undergoing carotid artery stenting. The aim of this analysis is to identify risk predictors for periprocedural stroke in patients ≥80 years old. METHODS-: Symptomatic patients with ≥50% stenosis and asymptomatic patients with ≥80% stenosis were enrolled. Patients' neurological status was assessed by an independent neurologist before as well as 24 hours and 30 days postprocedure. All strokes and suspected strokes were adjudicated by an independent committee. Logistic regression analysis was conducted to identify baseline demographic, lesion, procedural, or comorbidity parameters associated with outcomes in patients ≥80 years of age. RESULTS-: As of January 10, 2009, 5297 patients underwent carotid artery stenting in 186 US CAPTURE 2 clinical centers and 1166 were ≥80 years old. Octogenarians were similar to nonoctogenarians in terms of gender and symptomatic status but had fewer of certain risk factors (prior myocardial infarction or carotid endarterectomy, diabetes, smoking history) and more cardiac arrhythmia and renal insufficiency. For the overall cohort, death/stroke rate was 3.3%; stroke rate was 2.7% (0.8% major, 1.9% minor). Death/stroke rates were significantly higher for octogenarians than nonoctogenarians (4.5% versus 3.0%) as were stroke rates (3.8% versus 2.4%). Symptomatic status, embolic protection device dwell time, and lesion length were risk predictors for periprocedural stroke in octogenarians. CONCLUSIONS-: Patients ≥80 years old have higher periprocedural event rates than nonoctogenarians. Age, symptomatic status, and lesion length should be considered when identifying appropriate candidates for the procedure.

KW - Carotid artery stenting

KW - Octogenarians

KW - Outcome

KW - Risk predictors

KW - Stenosis

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=77950287117&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950287117&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.109.569426

DO - 10.1161/STROKEAHA.109.569426

M3 - Article

C2 - 20185789

AN - SCOPUS:77950287117

VL - 41

SP - 757

EP - 764

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 4

ER -