Author + information
- Received March 8, 2014
- Accepted May 8, 2014
- Published online November 1, 2014.
- Giuseppe Giugliano, MD∗,
- Eugenio Stabile, MD, PhD†∗ (, )
- Giancarlo Biamino, MD∗,
- Giampaolo Petroni, MD∗,
- Anna Sannino, MD†,
- Linda Brevetti, MD†,
- Armando Pucciarelli, MD∗,
- Grigore Popusoi, MD∗,
- Tullio Tesorio, MD∗,
- Angelo Cioppa, MD∗,
- Linda Cota, MD∗,
- Luigi Salemme, MD∗,
- Antonio Sorropago, BS†,
- Angelo Ausania, MD∗,
- Giovanni Della Pietra, MD∗,
- Arturo Fontanelli, MD∗,
- Bruno Trimarco, MD†,
- Giovanni Esposito, MD, PhD† and
- Paolo Rubino, MD∗
- ∗Montevergine Clinic, Mercogliano, Italy
- †Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- ↵∗Reprint requests and correspondence:
Dr. Eugenio Stabile, Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini 4, Naples NA 80131, Italy.
Objectives The aim of this study was to identify predictors of occlusion intolerance (OI) developing during proximal protected carotid artery stenting (CAS).
Background The use of proximal embolic protection devices, such as endovascular occlusion, during CAS has been demonstrated to be particularly safe and effective. However, endovascular occlusion can expose the ipsilateral hemisphere to hypoperfusion and produce transient neurological symptoms (OI).
Methods From March 2010 to March 2012, 605 consecutive patients underwent proximal protected CAS at our institution. To identify independent predictors of OI, a multivariate logistic regression model was developed that included all patients’ clinical/angiographic and procedural characteristics.
Results OI developed in a total of 184 patients (30.4%). Compared with patients in whom OI did not develop, those who experienced OI had lower occlusion pressure (OP) (42.3 ± 12.7 mm Hg vs. 61.9 ± 15.4 mm Hg, p < 0.001). Receiver-operating characteristic curve analysis demonstrated that OP was the most consistent predictor of OI with a C-statistic of 0.85 (95% confidence interval [CI]: 0.82 to 0.88) with best cutoff being ≤40 mm Hg (sensitivity, 68.5%; specificity, 93.3%). By logistic regression analysis, the most powerful independent predictor of OI developing was an OP ≤40 mm Hg (odds ratio: 33.2, 95% CI: 19.1 to 57.7) and the most powerful clinical predictor of such OP was the presence of contralateral internal carotid artery occlusion (odds ratio: 3.1, 95% CI: 1.5 to 6.2).
Conclusions OI may occur in as many as one-third of the patients undergoing proximal protected CAS. This event is more common in those patients with an OP ≤40 mm Hg. Patients presenting with concomitant occlusion of the contralateral internal carotid artery more frequently have an OP ≤40 mm Hg.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Giugliano and Stabile contributed equally to this work and are co-first authors. Drs. Esposito and Rubino contributed equally to this work and are co-senior authors.
- Received March 8, 2014.
- Accepted May 8, 2014.
- American College of Cardiology Foundation