Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Outcomes of Carotid Artery Stenting in Elderly Patients: A Single Center Retrospective Study: The Effect of Post-dilatation on Outcomes
Yaşlı Hastalarda Karotid Arter Stent Sonuçları: Tek Merkezi Retrospektif Bir Çalışma: Post-dilatasyonun Sonuçlara Etkisi
Aydın AKYÜZa, Muhammet Mucip EFEa, Demet ÖZKARAMANLI GÜRa, Şeref ALPSOYa, Niyazi GÜLERb
aDepartment of Cardiology, Namık Kemal University Faculty of Medicine, Tekirdağ, TURKEY
bClinic of Cardiology, Private Yaşam Hospital, Tekirdağ, TURKEY
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(1):7-14
doi: 10.5336/cardiosci.2020-78229
Article Language: EN
Full Text
ABSTRACT
 Objective: Carotid artery stenting (CAS) is a current treatment approach that has been applied in symptomatic and asymptomatic carotid artery stenosis. In addition to being a minimally invasive method, it has fewer complications and mortality rates, and short hospital stays when compared to carotid endarterectomy. Some studies showed that the risk of stroke or death twice as high after CAS than after carotid endarterectomy among those ≥70 years old. In this study, we aimed to investigate the short- and long-term complications, efficacy, and durability of CAS in elderly patients (≥70 years old) with carotid artery stenosis with a median follow-up of 5.08 years (interquartile range 3.2-8.1), respectively. Material and Methods: A total of 140 patients who underwent CAS due to atherosclerotic carotid artery stenosis were included in the study. Stroke rates (total n=15[10.7%], n=3[5%] vs n=12[15%], p=0.049) were higher in patients who were ≥70 years of age during the follow-up. The two groups (the group with age <70 and the group with age ≥70) were compared according to demographic, biochemical data, and clinical outcomes such as stroke and stroke/death. Results: According to multivariate logistic regression analysis, those who were ≥70 years, those with a history of earlier stroke, and the patients requiring post-dilatation were at risk of recurrent stroke. Deaths occurred in 5 of 140 patients in the follow-up. The patients who were ≥70 years (OR 4.577 [95% CI=1.023-5.544], p=0.043), who have a history of earlier stroke (OR=6.965 [95% CI=1.067-13.115], p=0.038), and those requiring post-dilatation (OR=2.312 [95%CI=1.156-5.775], p=0.022) were at risk of recurrent stroke. Only age ≥70 years (OR=4.577 [95% CI=1.210-17.191], p=0.024) was an important risk factor for death/stroke. Conclusion: Although the immediate results of the CAS procedure in patients with age ≥70, were successful, they, especially in those with a history of earlier stroke and those requiring post-dilation, had a higher risk of stroke and the combined endpoint of death/stroke in the follow-up.

Keywords: Carotid arteries; stents; stroke; death
ÖZET
 Amaç: Karotid arter stentlemesi (KAS), semptomatik ve asemptomatik karotid arter stenozunda uygulanan güncel bir tedavi yaklaşımıdır. Minimal invaziv bir yöntem olmasının yanı sıra, karotis endarterektomi ile karşılaştırıldığında daha az komplikasyon ve mortalite oranına sahiptir ve hastalar hastanede daha kısa kalmaktadır. Bazı çalışmalar, 70 yaş ve üzeri kişilerde inme veya ölüm riskinin karotis endarterektomiye göre KAS sonrası 2 kat daha yüksek olduğunu göstermiştir. Biz ortalama 5,08 yıl (çeyrekler arası aralık 3,2-8,1) takip edilen karotis arter darlığı olan yaşlı hastalarda KAS'ın kısa ve uzun dönem komplikasyonlarını, etkinliğini ve dayanıklılığını araştırmayı amaçladık. Gereç ve Yöntemler: Aterosklerotik karotis arter darlığı nedeniyle KAS uygulanan 140 hasta çalışmaya dâhil edildi. Takip sırasında ≥70 yaş olan hastalarda inme oranları (toplam n=15 [%10,7], n=3 [%5] vs n=12 [%15], p=0,049) daha yüksekti. İki grup (70 yaşın altında olan grup ve 70 yaş ve üzerinde olan grup) demografik, biyokimyasal veriler ve ölüm ve ölüm/inme gibi klinik sonuçlara göre karşılaştırıldı. Bulgular: Çok değişkenli lojistik regresyon analizine göre, ≥70 yaş ve daha erken inme öyküsü olanlar ve post-dilatasyon balon işlemi yapılanlar tekrarlayan inme riski altındaydı. İzlemdeki 140 hastanın 5'inde ölüm meydana geldi. ≥70 yaşında olan hastalar (göreceli olasılık oranı [GOO]=4,577 [%95 güvenlik aralığı (GA)=1,023-5,544], p=0,043), daha önce inme öyküsü olan hastalar (GOO=6,965 [% 95 GA=1,067-13,115], p=0,038) ve post-dilatasyon gerektirenler (GOO=2,312 [%95 GA=1,156-5,775], p=0,022) tekrarlayan inme riski altındaydı. Sadece 70 yaş ve üzeri (GOO=4,577 [%95 GA=1,210-17,191], p=0,024) ölüm/inme için önemli bir risk faktörüydü. Sonuç: Her ne kadar 70 yaş ve üstü olan hastalarda, KAS prosedürünün erken sonuçları başarılı olsa da sonraki yaşam takibinde özellikle post-dilatasyon yapılması gerekenler ve önceden inme hikayesi olanlarda, inme riski ve kombine ölüm/inme sonlanım noktaları daha yüksekti.

Anahtar Kelimeler: Karotis arterleri; stentler; inme; ölüm
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