Abstract 129: Periprocedural Events between Patients 70 Years and Older and less than 70 years who underwent Carotid Artery Stenting Comparted to the Historic Crest Trial; A Multicenter Cohort.
Authors: Lodi Y. M. , Reddy V. , Wang T. 
Published: January 2025

Background
Equal benefits and comparable periprocedural events were observed between carotid endarterectomy (CEA) and carotid artery stenting (CAS) group in CREST trial. However, CAS group had more cerebral ischemic events (CIE) compared to CEA and patients ≥ 70 years have signaled better chance with CEA. In CAS arm more patients were smoker and 12% of the patient was not on dual antiplatelets for 4 weeks. Objective of this study is to evaluate the incidence of perioperative events including CEI in patients ≥ 70 years who underwent with CAS and compared to the younger and historic CREST trial.

Methods
From a prospectively maintained data base, consecutive patient who underwent CAS for ≥ 70% were collected and retrospectively analyzed from January 2012 to December 2020. Patients demographics, procedural techniques and perioperative events were captured. Outcome was measured using modified ranking scale (mRS). Patients stopped smoking for 2 weeks and received loading dose of dual antiplatelets on the day prior to the CAS and dual antiplatelets full dose was continued for 30 days followed by two 81 mg aspirin and plavix 75 for additional 9 months (antiplatelets strategies).

Results
off 177, 86 (48.6%) patients were ≥ 70 years with a median age of 69 (39‐91) female 39.55%, symptomatic 71% asymptomatic 29% underwent CAS in two community based tertiary care facilities. All patients, but one received conscious sedation who underwent general anesthesia. Embolic protection device (EPD) was used in 69% and 41% didn't receive EPD due to the tortuosity or critical stenosis prevented EPD to cross the lesion. Stent couldn't be deployed in one because of non‐tolerance and underwent CEA. The overall perioperative events without death, stroke and MI was observed in 7 cases (3.9%) and in ≥ 70 years patients it was 2.3% compared to CREST CEA 6.8% including death, stroke and MI. Total perioperative CIE were observed in 2 cases (1.2%) and in ≥ 70 years, it was 1.16% (1patient) compared to CREST CEA 2.3%; both events developed in symptomatic CAS cases. First event was in a 65 Y/O man with left MCA stroke due to the left ICA stenosis. Patient baseline aphasia and right‐hand fine motor activity worsen after the procedure and resolved in 2 weeks without any MRI evidence of stroke. The second event was observed on an 84‐year‐old man as a right fascial droop which resolved over 4 weeks. Groin complications in all patients was 2.42% (4patients) and in ≥ 70, it was 1.16% in 1patient; anterior small hematoma in 3, closure device related ischemic leg in a 65‐year‐old who required urgent repair and achieved mRS 0. Asymptomatic patients achieved their baseline mRS.

Conclusions
Our study demonstrated no differences in CAS related perioperative events in patients ≥ 70 years compared to the younger with overall low rate of events. When compared with historic CREST CEA arm, our events rate was lower and with no death or MI. These may be related to the cessation of smoking and adherence to dual antiplatelets strategies in our cohort. Further studies are required.