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Postoperative Disability and Associated Outcomes for Patients Suffering a Stroke after Carotid Artery Stenting
Andrea Alonso1, Jeffrey Melvin1, Alik Farber1, Elizabeth King1, Karan Garg2, Katie Shean3, Thomas O'Donnell4, Denis Rybin1, Jeffrey Siracuse1
1Boston University School of Medicine, Boston, MA, 2NYU Langone Health, New York, NY, 3St. Elizabeth's Medical Cente, Brighton, MA 4Columbia University Irving Medical Center, New York, NY

Background: Stroke after a carotid artery stenting (CAS) is rare. However, their effects and long-term impact are variable and unclear. Our goal was to assess the degree of disability from a stroke after CAS procedures and their associated one-year outcomes.
Methods: The Vascular Quality Initiative CAS registry (2016-2023) was queried for transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (TFCAS) procedures for asymptomatic disease. The modified Rankin score (mRS) was used to categorize stroke-related disability and assess associations with one-year outcomes.
Results: There were 23,435 TCAR and 7,487 TFCAS procedures performed. There were 1.23% TCAR patients with a periprocedural stroke with a disability distribution of 61 (37.6%) mild, 58 (31.0%) moderate, 54 (28.9%) severe disability, and 14 (71.5%) deceased. There were 1.61% TFCAS with a periprocedural stroke with a disability distribution of 26 (37.7%) mild, 22 (31.0%) moderate, 19 (27.5%) severe disability, and 2 (2.9%) deceased. Severe postoperative disability was associated with increased one-year mortality (HR 11.04, 95% CI 6.9 - 17.7, P=.001) and neurological events (OR 10.82, 95% CI 6.93 - 16.9, P=.001) (table). Stroke after TFCAS had higher one-year mortality (HR 1.27, 95% CI 1.10, 1.47, P=.001) and neurological events (OR 1.27, 1.11,1.45, P<.001).
Conclusion: Most patients who undergo CAS for asymptomatic disease who had a periprocedural stroke had substantial disability. Stroke after TFCAS had worse one-year outcomes, as compared to TCAR.
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