Research Determines Risk of Carotid Stenting in Patients Over 75

New research may help doctors understand when carotid surgery should be preferred over carotid stenting according to a press release issued by Louisiana State University Health Sciences Center at New Orleans' School of Medicine. The study sought to explain why older patients have a risk of embolization and stroke during carotid artery stenting

"We hypothesized that elderly patients have more heavily calcified arches than younger patients," noted Dr. Bazan, lead author of the study, in a press release. "It is possible that heavily calcified aortic arches could be a source of increased embolization during wire manipulation and catheter exchanges at some stage in carotid artery stenting. We also sought to define what the arches look like or what their morphology is and found that in patients over the age of 75 years, there was a dramatic increase in calcium content and more complex aortic arches."

Patients over the age of 80 years have statistically had a larger chance of complications such as embolization and stroke during carotid artery stenting. Carotid artery stenting is when a foreign object is inserted into an artery to help promote blood flow through the artery. The carotid artery procedure is commonly recommended to prevent strokes.

During the study, the aortic arch type and calcium content was noted in patients. This was in an attempt to determine if the calcium content was related to the age of the patient or the aortic arch type. The researchers found a relation between the age of the patient and the calcium content; they found that there was a much larger risk if the patient was 75 years or older.

The researchers also found that the older patients in the study were more likely to have elongated arches. Those patients with these arches were also more likely to have complications during a stenting.

"Early identification of these arches at higher risk for embolic complications may allow planning of alternative techniques associated with less manipulation of the arch, such as the use of soft-tip guide catheters rather than stiff sheaths or use of the transcervical approach," said Dr. Bazan in the press release. "These maneuvers could potentially decrease the periprocedural risk of stroke. "

By using the aortic arch calcium content and the elongation of the arches, doctors should be able to make the best recommendation for treatment that will minimize unnecessary complications. Strokes are the third leading cause of death in the United States, with approximately 1 in 16 fatalities attributed to them each year.

SOURCES:

Louisiana State University Health Science Center, "Research sheds light on carotid artery stenting risk in elderly" Eurekalert