Patient Risk Factors for Carotid Revascularization

January 24, 2017

The Cardiovascular Health Study identifies patient factors that can be modified to stem risk for CEA.

 

Current guidelines on carotid revascularization require a minimum stenosis of 50%.1 Past studies have looked at ultrasound surveillance of disease progression as a risk factor for revascularization but little is known about patient-related risk factors. This short slide show summarizes results of a new study published in Cerbrovascular Diseases Extra.

 

 

 

The Cardiovascular Health Study included 5107 patients, aged ≥65y, with no history of carotid endarterectomy (CEA) or cerebrovascular disease and followed them for 13.5 years to evaluate CEA, CAS.

 

 

 

Strongest predictors of revascularization were baseline degree of stenosis (especially for ≥ 50% stenosis) and incident ischemic stroke.

 

 

Peripheral arterial disease was the patient factor associated with the greatest risk of revascularization, at 257%; followed by hypertension and LDL-C level.

 

 

 

Coronary artery stenting was not available to a significant portion of population; critical information about indication for procedures, images, and other data were not available for evaluation.

 

 

 

Authors note: “The associations of hypertension, PAD, and LDL-C with an increased risk of incident carotid revascularization..." underscore importance of these factors in diagnosis, management of carotid stenosis.

 

Take home points: Baseline degree of carotid stenosis, incident ischemic stroke were strongest predictors of revascularization; baseline hypertension, PAD, and LDL were linked to increased risk of revascularization; female gender, older age were linked to decreased risk of revascularization

 

References

1. Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid artery disease: Executive summary. Circulation 2011;124:489-532
2. Garg PK, Koh WJ, Delaney JA, et al. Risk factors for incident carotid artery revascularization among older adults. The Cardiovascular Health Study. Cerebrovasc Dis Extra. 2016;6:129-139.