A risk score to predict ischemic lesions after protected carotid artery stenting

Background and purpose: While carotid artery stenting can be performed safely in many patients, some have a higher risk for periprocedural complications. The detection of embolic lesions after CAS with DWI could become a useful means to identify these patients. The aim of this study was to determine risk factors for new DWI lesions after CAS. Methods: One hundred seventy-six patients who had undergone protected CAS with pre- and postprocedural DWI between November 2000 and December 2006 were included in this retrospective investigation. The association of potential angiographic and clinical risk factors with the incidence of any new ipsilateral DWI lesion after CAS was analyzed with logistic regression analysis. Subsequently, a simple risk score was developed using area under the curve (ROC) statistics. Results: The proportion of patients with any new ipsilateral DWI lesion was 51%. Advanced age (odds ratio (OR) 1.06; 95% confidence interval (CI) 1.01-1.11, p=0.008), the presence of an ulcerated stenosis (OR 2.28: 95% CI 1.10-4.75; p=0.027) or a lesion length > 1 cm (OR 2.65; 95% CI 1.33-5.28, p=0.006) were independent risk factors for new ipsilateral DWI lesions. A 4 point score ranging from 0 to 4 (age >= 70 years=1 point, age >= 80 years=2 points, lesion length > 1 cm=1 point, and presence of an ulcerated stenosis=1 point)reliably predicted the incidence of this outcome parameter (ROC=0.70, p < 0.001). Conclusions: A simple risk score can be used to identify patients at a high risk for new DWI lesions as a possible surrogate of embolic complications after CAS. (c) 2008 Elsevier B.V. All rights reserved.