Long-term survival and cerebrovascular events after carotid artery stenting in patients with chronic kidney disease

Abstract

Objective

Chronic kidney disease (CKD) is associated with cerebrovascular diseases (CVDs) due to chronic systemic inflammation. This study aimed to estimate perioperative and long-term outcomes in Chinese patients undergoing carotid artery stenting (CAS) who had different stages of CKD.

Method

This retrospective study enrolled 888 patients undergoing CAS for carotid artery stenosis. Patients were classified into normal, mild, moderate, and severe CKD and dialysis groups based on their renal function. The primary endpoint was long-term survival from a major adverse event (MAE), which was predefined as the development of a stroke, myocardial infarction (MI), or death during a 10-year long-term follow-up.

Results

Perioperative rates for MAE were 1.5 %, 1.8 %, 3.0 %, 10.3 %, and 9.1 % for the five categories (p < 0.001). There was no death within the perioperative 30 days. The estimated 5-year death-free survival rates decreased with worsening renal function (92.2 % vs. 82.7 % vs. 76.9 % vs. 61.4 % vs. 58.6 %, p < 0.001). The long-term MAE-free survival was 94.7 % vs. 91.0 % vs. 80.2 % vs. 63.7 % vs. 52.2 % for the groups, with the differences being significant between normal to moderate CKD and severe CKD and hemodialysis-dependent cases. Cox regression analysis revealed that dialysis (HR = 3.216 (95%CI: 1.662, 6.223), p = 0.001), severe CKD (HR = 4.592 (95%CI: 2.348, 8.982), p < 0.001), hypertension (HR = 1.977 (95%CI: 1.292, 3.024), p = 0.002), coronary artery disease (HR = 1.509 (95%CI: 1.037, 2.196), p = 0.032) and diabetes mellitus (HR = 2.459 (95%CI: 1.482, 4.079), p < 0.001) were predictors of long-term MAE after CAS.

Conclusion

Risk of perioperative and long-term MAE increased with CKD severity. Patients with normal to moderate CKD benefited from MAE-free survival after CAS. However, preventive CAS appeared to be inappropriate in severe CKD or hemodialysis cases with asymptomatic carotid stenosis, particularly in those with a number of comorbidities.