Abstract
Carotid artery stenting has been advocated as an alternative therapy to carotid endarterectomy in the treatment of patients with symptomatic and asymptomatic carotid stenosis, specifically for those at high risk for surgical revascularization.
The impact of chronic renal insufficiency on the long-term clinical outcome of carotid artery stenting has not been well established. We have previously shown that although the perioperative carotid artery stenting stroke rates for normal, moderate, and severe chronic renal insufficiency were not significantly different using either serum creatinine or the glomerular filtration rate as markers, the long-term outcomes were somewhat different. The rates of freedom from major adverse events (stroke, myocardial infarction, and death) at 3 years in symptomatic patients were 81 % in patients with normal renal function versus 46 % in patients with moderate/severe chronic renal insufficiency (p = 0.0198). This study also showed that the glomerular filtration rate was more sensitive in detecting late major adverse events after carotid artery stenting than serum creatinine. This study concluded that carotid artery stenting in moderate chronic renal insufficiency patients can be done with satisfactory perioperative outcomes; however the late death rate was significantly high.
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- CAS:
-
Carotid artery stenting
- CEA:
-
Carotid endarterectomy
- CRI:
-
Chronic renal insufficiency
- GFR:
-
Glomerular filtration rate
- MAE:
-
Major adverse events
- MDRD:
-
Modification of diet in renal disease
- MI:
-
Myocardial infarction
References
AbuRahma AF, Alhalbouni A, Abu-Halimah S, Dean LS, Stone PA. Impact of chronic renal insufficiency on the early and late clinical outcomes of carotid artery stenting using serum creatinine vs glomerular filtration rate. J Am Coll Surg. 2014;218:797–807.
Ascher E, Marks NA, Schutzer RW, Hingorani AP. Carotid endarterectomy in patients with chronic renal insufficiency: a recent series of 184 cases. J Vasc Surg. 2005;41:24–9.
Coresh J, Byrd-Holt D, Astor BC, Eggers PW, Lacher DA, Hostetter TH. Chronic kidney disease awareness, prevalence, and trends among U.S. adults, 1999 to 2000. J Am Soc Nephrol. 2005;16:180–8.
EVA-3S Investigators. Endarterectomy vs. angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) trial. Cerebrovasc Dis. 2004;18:62–5.
Gray WA, Hopkins LN, Yadav S, Davis T, Wholey M, Atkinson R, et al. Protected carotid stenting in high-surgical-risk patients: the ARCHeR results. J Vasc Surg. 2006;44:258–68.
Gray WA, Yadav JS, Verta P, Scicli A, Fairman R, Wholey M. The CAPTURE registry: predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting. Catheter Cardiovasc Interv. 2007;70:1025–33.
Hellerstedt WL, Johnson WJ, Ascher N, et al. Survival rates of 2,728 patients with end-stage renal disease. Mayo Clin Proc. 1984;59:776–83.
Hopkins LN, Myla S, Grube E, Wehman JC, Levy EI, Bersin RM, Joye JD, Allocco DJ, Kelley L, Baim DS. Carotid artery revascularization in high surgical risk patients with the NexStent and the Filterwire EX/EZ: 1-year results in the CABERNET trial. Catheter Cardiovasc Interv. 2008;71:950–60.
International Carotid Stenting Study Investigators. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomized controlled trial. Lancet. 2010;375:985–97.
Jackson BM, English SJ, Fairman RM, Karmacharya J, Carpenter JP, Woo EY. Carotid artery stenting: identification of risk factors for poor outcomes. J Vasc Surg. 2008;48:74–9. Epub 2008 May 23.
Kretz B, Abello N, Brenot R, Steinmetz E. The impact of renal insufficiency on the outcome of carotid surgery is influenced by the definition used. J Vasc Surg. 2010;51:43–50.
Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG, CREST Investigators. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke. 2010;41:S31–4.
Plecha EJ, King TA, Pitluk HC, et al. Risk assessment in patients undergoing carotid endarterectomy. Cardiovasc Surg. 1993;1:30–2.
Porter GA. Cardiovascular complications in end-stage renal disease patients. In: Cummings NB, Klahr S, editors. Chronic renal disease: causes, complications and treatment. New York: Plenum Medical Book Co.; 1985. p. 219–23.
Protack CD, Bakken AM, Saad WE, Davies MG. Influence of chronic renal insufficiency on outcomes following carotid revascularization. Arch Surg. 2011;146:1135–41.
Rigdon EE, Monajjem N, Rhodes RS. Is carotid endarterectomy justified in patients with severe chronic renal insufficiency? Ann Vasc Surg. 1997;11:115–9.
Ritz E, Wiecek A, Gnasso A, et al. Is atherogenesis accelerated in uremia? Contrib Nephrol. 1986;52:1–9.
Safian RD, Bacharach JM, Ansel GM, Criado FJ. Carotid stenting with a new system for distal embolic protection and stenting in high-risk patients: the carotid revascularization with ev3 arterial technology evolution (CREATE) feasibility trial. Catheter Cardiovasc Interv. 2004;63(1):1–6.
Saw J, Gurm HS, Fathi RB, Bhatt DL, Abou-Chebl A, Bajzer C, Yadav JS. Effect of chronic kidney disease on outcomes after carotid artery stenting. Am J Cardiol. 2004;94:1093–6.
Seliger SL, Gillen DL, Longstreth Jr WT, et al. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int. 2003;64:603–9.
Sidawy AN, Aidinian G, Johnson ON, White PW, DeZee KJ, Henderson WG. Effect of chronic renal insufficiency on outcomes of carotid endarterectomy. J Vasc Surg. 2008;48:1423–30.
SPACE Collaborative Group, Ringleb PA, Allenberg J, Bruckmann H, et al. 30-day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomized non-inferiority trial. Lancet. 2006;368:1239–47.
Tarakji A, McConaughy A, Nicholas GG. The risk of carotid endarterectomy in patients with chronic renal insufficiency. Curr Surg. 2006;63:326–9.
van Lammeren GW, Moll FL, Blankestijn PJ, de Kleijn DPV, Bots ML, Verhaar MC, de Vries JPM, Pasterkamp G. Decreased kidney function: an unrecognized and often untreated risk factor for secondary cardiovascular events after carotid surgery. Stroke. 2011;42:307–12.
White CJ, Iyer SS, Hopkins LN, Katen BT,Russell ME; BEACH Trial Investigators Carotid stenting with distal protection in high surgical risk patients; the BEACH trial 30 day results. Catheter Cardiovasc Interv. 2006;6:503–512.
Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;351:1493–501.
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AbuRahma, A.F., Stone, P.A. (2016). Carotid Artery Stenting and Outcome Predictors. In: Patel, V., Preedy, V. (eds) Biomarkers in Cardiovascular Disease. Biomarkers in Disease: Methods, Discoveries and Applications. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7678-4_33
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DOI: https://doi.org/10.1007/978-94-007-7678-4_33
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