Predictors of 30-day postoperative major adverse clinical events after carotid artery stenting: An analysis of the procedure-targeted American College of Surgeons National Surgical Quality Improvement Program.

Background: Information about carotid artery stenting (CAS) is largely derived from clinical trials, consensus statements, and outcomes comparisons between CAS and carotid endarterectomy. Given these limitations, the goal of this study was to identify risk factors for adverse outcomes after CAS among hospitals participating in the CAS-targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

Methods: Our study sample consisted of patients from the 2012 to 2015 CAS-targeted ACS NSQIP data set. The primary outcome variable was 30-day postoperative incidence of major adverse clinical events (MACEs; death, myocardial infarction/arrhythmia, ipsilateral stroke/transient ischemic attack). Univariable and multivariable analyses were performed to identify patient and procedural characteristics associated with MACEs.

Results: A total of 448 patients undergoing CAS for carotid artery stenosis were identified in the 2012 to 2015 CAS-targeted ACS NSQIP data set as eligible for analysis. The incidence of postoperative MACEs was 8.4% for symptomatic patients and 5.4% for asymptomatic patients. On multivariable analysis, independent predictors of MACEs included age ≥80 years, female sex, black race, presence of chronic obstructive pulmonary disease, active tobacco use (protective), and use of more than one stent.

Conclusions: The rate of major postoperative events in preoperatively asymptomatic patients is higher than the threshold recommended by the American Heart Association guidelines. Elderly patients (≥80 years), female patients, and black patients as well as those receiving more than one stent are at increased risk of negative outcome after CAS.