Retrospective evaluation of risk factors, short- and long-term prognostic factors in cases with carotid artery stenting

Cerebrovascular diseases (CVD) are among the first diseases that cause disability and death in the World. 75-80% of cerebrovascular diseases are ischemic strokes and 15% are hemorrhagic strokes. Carotid artery stenosis causes 10% of ischemic strokes. In addition, a direct relationship was found between the degree of carotid artery stenosis and the risk of ipsilateral stroke. Carotid artery stenting is being used more and more frequently in patients with carotid artery stenosis, and the indication limit may change from day to day with the increase in medical treatment options, especially in the asymptomatic patient group. For this reason, it has recently gained importance to perform perioperative risk assessments of patients with carotid artery stenosis and to indicate revascularization in suitable patients for risk assessments. In our study, it was aimed to define the short and long-term prognosis of patients who underwent carotid artery stenting, to better define the factors that play a role in the prognosis, and to determine the perioperative risk scales before the procedure. In the 30-day prognosis of 584 carotid stenting patients included in the study, major stroke was 2.4%, MI 2.2%, and minor stroke was 3.4%, and cerebrovascular accident developed on the stent side at a rate of 5%. The 30-day SVO or mortality rate of the patients was 7.7%. Considering the 30-day mortality, the vascular death rate is 1.4% and the nonvascular death rate is 0.5%. When 460 patients whose 1-year follow-ups were reached after carotid artery stenting were examined, the one-year major stroke rate, excluding the 30-day procedure complications, was 1.3%, the MI rate was 1.1%, and the MACCE rate was 2.2%. The 1-year restenosis rate was found to be 6.5%. In the 1-year mortality of the patients, it was noted that the vascular death rate was 1.1% and the nonvascular death rate was 1.3%. The 5-year follow-up information of 309 patients after carotid artery stenting was obtained. Major stroke rate was 1.3%, MI rate 7.8%, and MACCE rate 9.1%. The 5-year restenosis rate of the patients was 14.2%, and the stent-side stroke rate was 2.3%. Considering the 5-year mortality of 309 patients, it was noted that the vascular death rate was 1% and the nonvascular death rate was 3.2%. The 10-year follow-up information of 112 patients after carotid artery stenting was obtained. The 10-year total major stroke rate in patients was 6.2%, MI 19.6%, and MACCE 25.9%. The 10-year restenosis rate was 21.4%, while the stent-side stroke rate was 2.7%. In the 10-year mortality of the patients, it was noted that the vascular death rate was 8% and the nonvascular death rate was 12.4%. The significant increase in the 10-year MI and vascular death rates of the patients shows the importance of the ideal medical treatment for vascular risk factors together with the procedure. Considering the 10-year follow-up in the study group, the most common cause of death was infection with 20.2%. It was observed that infections developed secondary to their underlying diseases in long-term follow-up independent of the procedure. At follow-up, 8 patients (9%) died due to major ischemic stroke, 8 patients died due to MI. A higher rate of stroke, MI was observed in smokers in the 10-year follow-up group, in the symptomatic patient group, and in patients with clopidogrel resistance. The vascular death rate was found to be higher in patients with AF and in the symptomatic patient group during follow-up. In conclusion, although carotid stenting is a safe treatment, patients should be followed closely in terms of vascular risk factors and post-procedure complications, and preoperative risk assessment should be done carefully in terms of procedural indications. There is an increase in the risk of vascular events, especially in the long-term, in procedures performed without follow-up such as best medical treatment, lifestyle changes, smoking cessation programs.