Carotid artery stenting: Do procedural complications relate to the side intervened upon?

Objectives : To determine the influence of the side intervened upon on outcomes during carotid artery stenting (CAS). Background : Anatomic and technical aspects may influence the results of CAS. The value of the side intervened upon has not been analyzed yet. Methods : We analyzed data from the Carotid Artery Stent (CAS) – Registry. Results : A total of 3,165 CAS procedures, 1,613 (51%) at the left and 1,552 (49%) at the right carotid artery were included. There was a higher proportion of patients treated for symptomatic stenoses when CAS was performed at the left carotid artery (50.1% versus 45.8%, P = 0.016) and more patients already had prior carotid endarterectomy (8.5% versus 5.8%, P = 0.003). Interventions at the left side took 3 min longer than interventions at the right side (46.6 ± 24.3 versus 43.8 ± 23.6, P = 0.003). In patients treated at the left carotid artery amaurosis fugax (0.7% versus 0.1%, P = 0.005), ipsilateral stroke (3.1% versus 1.8%, P = 0.017), and the primary endpoint of in‐hospital death or stroke (4.1% versus 2.3%, P = 0.005) occurred significantly more often. Even after adjusting for confounding parameters, CAS procedures performed at the left carotid arteries remained an independent predictor of death or stroke (OR = 1.77, 95% CI: 1.15–2.72, P = 0.009). Conclusions : In current clinical practice, CAS is performed frequently at the right carotid artery as at the left carotid artery. CAS interventions have a higher in‐hospital complication rate if performed at the left carotid artery. Technical improvements might help to overcome this situation. © 2009 Wiley‐Liss, Inc.