Stroke: Vascular and Interventional Neurology (Jan 2025)

Carotid Artery Stenting Outcomes by Neurointerventional Surgeons (CASONI)

  • Mohamad Ezzeldin,
  • Ameer E. Hassan,
  • Ali Kerro,
  • Maria Martucci,
  • Muhammad Shazam Hussain,
  • Osman Mir,
  • Faheem G. Sheriff,
  • Peter Kan,
  • Chizoba Ezepue,
  • Nazli A. Janjua,
  • Kaiz S. Asif,
  • Ramesh Grandhi,
  • Ali Alaraj,
  • Muhammad Niazi,
  • Ossama Yassin Mansour,
  • Michael Chen,
  • Saif Bushnaq,
  • Omar Tanweer,
  • Adnan H. Siddiqui,
  • Adam Delora,
  • Rime Ezzeldin,
  • Bains Navpreet,
  • Varun Chaubal,
  • Mohammad Ammar Abdulrazzak,
  • Hamzah Saei,
  • Gustavo J. Rodriguez,
  • Mohammad AlMajali,
  • Gautam Edhayan,
  • Amer Al Shekhlee,
  • Christopher Hadjialiakbari,
  • Musaab Froukh,
  • Walid K. Salah,
  • Elsa Nico,
  • Adrusht Madapoosi,
  • Yazan Radiaideh,
  • Darko Quispe‐Orozco,
  • Oz Haim,
  • Noel Garza,
  • Alberto Maud,
  • Morgan Rolon‐Newton,
  • Benan Barakat,
  • Tejas Gowda,
  • Muhammad Monk,
  • Zuhair Ali,
  • Tunmi Anwoju,
  • Osama O. Zaidat,
  • Farhan Siddiq

DOI
https://doi.org/10.1161/SVIN.124.001459
Journal volume & issue
Vol. 5, no. 1

Abstract

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Background Multiple studies have highlighted the importance of carotid artery stenting (CAS) operator's experiences. However, fellowship‐trained neurointerventionalists remain an under‐represented specialty in the literature. We aim to report the complication rate of CAS performed exclusively by neurointerventionalists. Methods Retrospective cohort study regarding stenting symptomatic and asymptomatic carotid stenosis was collected at multiple comprehensive stroke centers. The primary outcome included a composite of the 30‐day periprocedural mortality, symptomatic ischemic stroke, symptomatic intracranial hemorrhage, and myocardial infarction. The secondary outcomes included other complications. Chi‐squared tests were performed for categorical variables, and Welch's t‐test was used for continuous variables. Cutoffs in continuous variables were estimated using grid search optimization. Sensitivity analyses were performed for missing data. Results Between 2018 and 2022, 1445 CAS procedures were performed by 38 neurointerventionalists. We have 30‐day outcome data on 1281 patients. Patients were predominantly symptomatic (93.01%), male (65.79%), White (70.36%), and had a median age of 69. The primary outcomes occurred in 26 (1.8%) cases, with 13 (0.9%) death, 8 (0.55%) symptomatic ischemic stroke, 4 (0.28%) symptomatic intracranial hemorrhage, and 1 (0.07%) myocardial infarction. A statistically significant increase in all outcomes correlated with advanced age (P = 0.001), women (P = 0.013), aortic arch type 3 (P = 0.01), and higher preprocedural modified Rankin score (P = 0.006). Secondary outcomes were higher in Hispanic and Black patients (P = 0.007) and those with low diastolic blood pressure at stenting (P = 0.04). Conclusion CAS, conducted by fellowship‐trained neurointerventionalist physicians in comprehensive stroke centers, demonstrates a lower complication rate than what was previously reported in CAS, carotid endarterectomy, and transcarotid artery revascularization literature. Physician training, higher frequency, and standardized stroke care in a comprehensive stroke center may contribute to this low complication rate.

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