CAS and heart valve disease association

Q: Which cardiac valvular disease is found to be a risk factor for poor outcomes in carotid artery stenting (CAS)? (select one)

A) Aortic stenosis
B) Aortic regurgitation


Answer: A

CAS requires an experienced hand as many factors affect the outcome of the procedure including age older than 80, female gender, the burden of calcification and ulceration of carotid plaque, contra-lateral carotid stenosis, prior neck irradiation, high hemoglobin A1C, renal insufficiency, anti-coagulation on board, and emergency admission.

As far as cardiac valvular disease is concerned, aortic stenosis is found to be associated with a higher risk for CAS poor outcomes.

#surgical-critical-care


References:

1. Hofmann R, Niessner A, Kypta A, et al. Risk score for peri-interventional complications of carotid artery stenting. Stroke 2006; 37:2557. 

2. Jackson BM, English SJ, Fairman RM, et al. Carotid artery stenting: identification of risk factors for poor outcomes. J Vasc Surg 2008; 48:74. 

3. Howard VJ, Voeks JH, Lutsep HL, et al. Does sex matter? Thirty-day stroke and death rates after carotid artery stenting in women versus men: results from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) lead-in phase. Stroke 2009; 40:1140. 

4.  Donahue M, Visconti G, Focaccio A, et al. Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Internal Carotid Artery Stent Implantation. JACC Cardiovasc Interv 2015; 8:1506.