Predictors of unfavorable long-term outcomes of internal carotid artery stenting

Aim. To identify factors influencing the clinical outcomes of endovascular treatment of patients with hemodynamically significant internal carotid artery (ICA) disease in the long-term postoperative period.

Material and methods. From February 2013 to January 2022, carotid stenting was performed in 288 patients (223 men, 65 women) aged 4086 years for hemodynamically significant ICA disease at the National Medical Research Center for Therapy and Preventive. The retrospective part analyzed patient records (n=110), while the prospective part included 178 patients. During the 12-month postoperative follow-up, the incidence of cerebrovascular events (transient ischemic attacks, minor and major strokes, transient monocular blindness, acute myocardial infarction, all-cause mortality, restenosis in the stenting area, and the need for reinterventions) was monitored. To identify significant prognostic factors, the relationship between long-term clinical outcomes and the following groups of parameters was analyzed: morphological stenosis characteristics, patient clinical and anamnestic data (age, comorbidities), and technical features of the endovascular intervention.

Results. Multivariate analysis identified predictors of the composite endpoint (death + myocardial infarction + stroke + transient ischemic attack + repeat revascularization). Among clinical factors, obesity demonstrated independent prognostic value, with a hazard ratio (HR) of 1,89 (95% confidence interval (CI): 1,28-4,73, p=0,042). The anatomical and morphological characteristics of the lesion had the greatest impact on the incidence of events: complicated plaque (ulceration, thrombosis, or hemorrhage) — HR 3,47 (95% CI: 1,258,68, p=0,029); stenosis length ≥15 mm — HR 2,12 (95% CI: 1,414,03, p=0,032). Technical aspects of the intervention were of great importance — residual stenosis in the range of 10-30% — HR 2,38 (95% CI: 1,38-3,48, p=0,011).

Conclusion. The obtained data emphasize the need for a thorough assessment of the lesion morphology and achieving an optimal angiographic data during carotid artery stenting, especially in obese patients with extensive stenoses. The identified risk factors can be used to stratify patients and develop personalized approaches to postoperative follow-up.

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