Easy-to-Use Risk Score Shows Benefits for Guiding CAS

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May 9, 2012—The Society for Cardiovascular Angiography and Interventions (SCAI) announced the presentation of a simple clinical assessment performed in the doctor’s office can identify patients who are at high risk for stroke and other major complications after carotid artery stenting (CAS) procedures.

In its press release, SCAI noted that the assessment includes five clinical characteristics, requires no invasive tests, and provides valuable guidance to patients considering stenting for carotid artery disease. Beau M. Hawkins, MD, presented the assessment technique at the SCAI 2012 scientific sessions in Las Vegas, Nevada. The assessment procedure was developed by Dr. Hawkins and colleagues at Massachusetts General Hospital.

“We can see someone in the office and gauge risk very quantitatively without having to do angiography,” commented Dr. Hawkins in an SCAI press release. “That gives patients important information. It allows them to be more active in the decision-making process.”

As summarized by SCAI in its press release, the study investigators analyzed data from thousands of patients in the National Cardiovascular Data Registry’s CARE Registry, which collects clinical information and procedural results on patients treated with CAS. Among the 11,122 procedures the researchers reviewed, there was a total of 304 major complications such as stroke, heart attack, or death (2.7%). After sifting through more than 30 characteristics from the patients’ clinical histories and x-ray angiography tests, the investigators developed a risk score based on five factors that significantly increased the likelihood of major complications after CAS.

These factors and their contribution to the risk score are age (+2 points for each decade over age 50, up to a maximum of 10 points), atrial fibrillation (+2 points), previous stroke (+3 points), stroke-like symptoms from the carotid artery blockage within the previous 6 months (+2 points), and major surgery planned in the near future (+4 points).

By using this risk score, the investigators could predict the likelihood of major complications for a given patient. When patients were divided into low-, intermediate-, and high-risk groups by their score, the rates of major complications rose accordingly (1.4%, 4%, and 7.1%, respectively).

“This gives both clinicians and patients a simple, easy-to-use tool that informs us about the patient’s risk of undergoing carotid artery stenting,” stated Dr. Hawkins. “That’s important—and much needed—because it tells us who is at exceptionally high risk and probably should consider other treatments for their carotid artery disease.”

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