Young Patients Undergoing Carotid Stenting Procedures Have An Increased Rate Of Late Procedural Failure
Karan Garg, MD1, Heepeel Chang, MD1, Mikel Sadek, MD1, Glenn Jacobowitz, MD1, Thomas Maldonado, MD1, Neal Cayne, MD1, Jeffrey Siracuse, MD1, Caron B. Rockman, MD2.
1New York University Langone Medical Center, New York, NY, USA, 2New York University Langone Medical Cent, New York, NY, USA.
OBJECTIVES: The outcomes of patients with premature cerebrovascular disease (≤ 55 years) who undergo carotid stenting are not well defined. Our study objective was to analyze outcomes of younger patients undergoing carotid stenting. METHODS: SVS VQI was queried for TF-CAS and TCAR (2003-2020). Patients were stratified based on age ≤ or > 55. Primary endpoints were periprocedural stroke, death, MI, and composite outcomes. Secondary endpoints analyzed included late procedural failure, defined as ipsilateral restenosis (≥80%), occlusion, or reintervention RESULTS: Of 41,241 patients undergoing TF-CAS or TCAR, 2912 (7.1%) were ≤ 55 years (mean 49.3). Younger patients were less likely to have coronary disease (38% vs. 55%), diabetes (30.4% vs. 37.9%) and hypertension (72% vs. 89.9%), but were more likely to be female (43.5% vs. 35.4%) and active smokers (51.4% vs. 24.4%). (all p< .001) Younger patients were more likely to have had prior TIA or stroke than older patients (69.1% vs. 56.2, p< .001). Younger patients were less likely than older patients to undergo TCAR as opposed to TF-CAS (14.1% vs. 34.6%, p< .001). Younger patients had similar rates of periprocedural stroke (1.6% vs. 2.0%, p=NS), and stroke/death (2.5% vs. 2.8%, p=NS), but were less likely to have a periprocedural MI (0.3% vs, 0.7%, p<.001). Mean follow-up was 12 months with no difference between cohorts. During follow up, younger patients were significantly more likely to experience significant (≥ 80%) restenosis (4.9% vs. 2.4%) and to undergo carotid reintervention (3.6% vs. 2.0%) (both p< .001). Young patients were more likely to have a late TIA or stroke than older patients, although this did not reach statistical significance (3.8% vs. 3.2%). Finally, younger patients were significantly more likely to have any anatomic failure than older patients, both overall (7.8% vs. 4.0%), following TCAR (6.7% vs. 2.9%), and following TF-CAS (8.0% vs. 4.7%) (all p < .001). CONCLUSIONS: Patients with premature cerebrovascular disease undergoing carotid stenting are more likely to be female, active smokers, and symptomatic. Although periprocedural outcomes are similar, younger patients have higher rates of late procedural failures, including significant restenosis, occlusion, and reintervention, even during a short follow up period. Clinicians should carefully consider the indications for carotid stenting in patients with premature cerebrovascular disease, and carefully follow those who undergo TCAR or TF-CAS.
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