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Purpose <p>To identify anatomical risk factors for poor perioperative outcomes in patients treated with carotid artery stenting (CAS). To compare long-term results for patients with favourable and hostile anatomy (HA) for CAS.</p> Material and Methods <p>Single-centre, retrospective study of patients who underwent CAS from 2004 to 2024 at a public hospital in Latin America. Anatomical data were extracted from preoperative imaging regarding the aorta, the supra-aortic trunks, and the internal carotid arteries (ICA). Short-term outcomes included the primary composite outcome of major stroke and death (S/D); any ischaemic neurological event (AINE); major stroke, any stroke. Multivariate analysis (MA) was performed to identify classifying anatomical factors regarding hostility to CAS. Long-term outcomes, defined as AINE; cumulative survival; major stroke-free survival; and stent primary patency (SPP), were analysed using Kaplan–Meier estimates.</p> Results <p>MA associated hostile anatomy with complex ICA, defined as either significant tortuosity or near-occlusion. One hundred and eighty-seven CAS procedures were performed in 172 patients, of which 79 (42.3%) had HA. HA correlated with a higher perioperative incidence of AINE (<i>p</i> = .018), any stroke (<i>p</i> = .029), and S/D (<i>p</i> = .049), but not with major stroke (<i>p</i> = .054). At 5&#xa0;years, the HA group presented higher cumulative incidence of AINE (<i>p</i> = 0,047) and lower SPP (<i>p</i> = 0,011). There were no differences between groups for cumulative survival and major stroke-free survival.</p> Conclusion <p>The presence of a significantly tortuous or near-occluded ICA correlated with higher incidence of AINE and S/D in patients submitted to CAS. HA for CAS correlated with higher cumulative incidence of AINE and lower SPP rates during follow-up.</p> Graphical Abstract <p></p>

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The Influence of Arterial Anatomy on Early and Late Outcomes of Carotid Artery Stenting

  • 期刊论文

  • 发表日期：

    2025年11月24日

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  • Eduardo Corvello Teixeira,
  • Hélio B Neto,
  • Erasmo S da Silva,
  • André E V Estenssoro,
  • Nelson de Luccia,
  • Pedro Puech Leão,
  • Ivan B Casella

摘要

Purpose

To identify anatomical risk factors for poor perioperative outcomes in patients treated with carotid artery stenting (CAS). To compare long-term results for patients with favourable and hostile anatomy (HA) for CAS.

Material and Methods

Single-centre, retrospective study of patients who underwent CAS from 2004 to 2024 at a public hospital in Latin America. Anatomical data were extracted from preoperative imaging regarding the aorta, the supra-aortic trunks, and the internal carotid arteries (ICA). Short-term outcomes included the primary composite outcome of major stroke and death (S/D); any ischaemic neurological event (AINE); major stroke, any stroke. Multivariate analysis (MA) was performed to identify classifying anatomical factors regarding hostility to CAS. Long-term outcomes, defined as AINE; cumulative survival; major stroke-free survival; and stent primary patency (SPP), were analysed using Kaplan–Meier estimates.

Results

MA associated hostile anatomy with complex ICA, defined as either significant tortuosity or near-occlusion. One hundred and eighty-seven CAS procedures were performed in 172 patients, of which 79 (42.3%) had HA. HA correlated with a higher perioperative incidence of AINE (p = .018), any stroke (p = .029), and S/D (p = .049), but not with major stroke (p = .054). At 5 years, the HA group presented higher cumulative incidence of AINE (p = 0,047) and lower SPP (p = 0,011). There were no differences between groups for cumulative survival and major stroke-free survival.

Conclusion

The presence of a significantly tortuous or near-occluded ICA correlated with higher incidence of AINE and S/D in patients submitted to CAS. HA for CAS correlated with higher cumulative incidence of AINE and lower SPP rates during follow-up.

Graphical Abstract