Author + information
- Received December 3, 2014
- Revision received May 13, 2015
- Accepted May 22, 2015
- Published online September 1, 2015.
- Michael Donahue, MD∗,
- Gabriella Visconti, MD∗,
- Amelia Focaccio, MD∗,
- Lucio Selvetella, MD†,
- Maria Baldassarre, MD†,
- Chiara Viviani Anselmi, PhD‡,§ and
- Carlo Briguori, MD, PhD∗∗ ()
- ∗Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy
- †Department of Vascular Surgery, Clinica Mediterranea, Naples, Italy
- ‡Institute of Genetic and Biomedical Research, National Research Council, Milan, Italy
- §Humanitas Clinical and Research Center, Rozzano, Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Carlo Briguori, Interventional Cardiology, Clinica Mediterranea, Via Orazio, 2, I-80121 Naples, Italy.
Objectives This study sought to investigate acute kidney injury (AKI) following carotid artery stenting (CAS).
Background Few data exist on AKI following CAS.
Methods This study evaluated 126 chronic kidney disease (CKD) patients who underwent CAS. The risk for contrast-induced AKI was defined by the Mehran score. Hemodynamic depression (i.e., periprocedural systolic blood pressure <90 mm Hg or heart rate <60 beats/min), AKI (i.e., an increase of ≥0.3 mg/dl in the serum creatinine concentration at 48 h), and 30-day major adverse events (including death, stroke, and acute myocardial infarction) were assessed.
Results AKI occurred in 26 patients (21%). Although baseline kidney function and contrast volume were similar in the AKI group and the non-AKI group, the risk score was higher (10 ± 3 vs. 8 ± 3; p = 0.032), and hemodynamic depression (mostly due to hypotension) (65.5% vs. 35%; p = 0.005) was more common in the AKI group. The threshold of hemodynamic depression duration for AKI development was 2.5 min (sensitivity 54%, specificity 82%). Independent predictors of AKI were hemodynamic depression (odds ratio [OR]: 4.01; 95% confidence interval [CI]: 1.07 to 15.03; p = 0.009), risk score (OR: 1.29; 95% CI: 1.03 to 1.60; p = 0.024), and male sex (OR: 6.07; 95% CI: 1.18 to 31.08; p = 0.021). Independent predictors of 30-day major adverse events that occurred more often in the AKI group (19.5% vs. 7%; p = 0.058) were AKI (HR: 4.83; 95% CI: 1.10 to 21.24; p = 0.037) and hemodynamic depression (HR: 5.58; 95% CI: 1.10 to 28.31; p = 0.038).
Conclusions AKI in CKD patients undergoing CAS is mostly due to hemodynamic depression and is associated with a higher 30-day major adverse events rate.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 3, 2014.
- Revision received May 13, 2015.
- Accepted May 22, 2015.
- American College of Cardiology Foundation