Original title: Risk Prediction for Adverse Events After Carotid Artery Stenting in Higher Surgical Risk Patients Reference: Neil J. Wimmer et al. 2012;43: 3218-3224 Stroke.
There are many patients with high surgical risk for carotid endarterectomy, either because of unfavorable anatomy, comorbidities or both. In this situation carotid angioplasty is a therapeutic option. However, no score has been developed to predict events in this specific group.
The study population comes from patients who were not randomized from the SAPPHIRE trial, (Stenting and Angioplasty with protection in Patients at High Risk for Endarterectomy), and entered into a prospective registry.
The objective was to develop and validate a score to predict death and stroke at 30 days in patients who received carotid angioplasty and who were at high surgical risk for endarterectomy.
We included 10,186 patients in total, between 2006 and 2010 of which (29.8%) had symptomatic lesions but all were high risk for surgery. At 30 days there was a 1.2% mortality rate (123 patients) and 3% suffered a stroke (301 patients). From this data the 10 independent predictors in the final model emerged.
Conclusion
We developed and validated a score that predicts death and stroke at 30 days in patients who received carotid angioplasty and were at high risk for an endarterectomy.
Editorial Comment:
It is a quick and easy score with a clinical application that can help us with a difficult decision beside the patient’s bed. External validity is uncertain since all patients used the same filter and stent, (ANGIOGUARD + PRECISE). All patients received carotid angioplasty beyond the risk, all were out of surgery and medical treatment was not an option, so the score would be limited to deciding between different treatment strategies.
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