Atrial arrythmia did not increase the risk of stroke or death within 30 days after carotid stent placement, with an odds ratio of 1.03 (95% CI 0.71-1.54).
Does the presence of atrial arrhythmia increase the risk of stroke or death within 30 days in patients undergoing carotid artery stent placement?
Patients with atrial arrhythmia undergoing carotid artery stenting do not have an increased risk of 30-day stroke or death compared to those without atrial arrhythmia.
Introduction: Patients with atrial fibrillation or flutter have been excluded from randomized clinical trials evaluating the effectiveness of carotid artery stent placement (CAS) in patients with internal carotid artery (ICA) stenosis. However, in general practice, approximately 15% of the patients being treated by CAS have atrial fibrillation and those patients may be at higher risk for periprocedural complications. We evaluated the risk of stroke, myocardial infarction and/or death within 30 days in patients undergoing CAS in patients with atrial arrythmia using real world data. Methods: We analyzed the data for patients with ICA stenosis who underwent CAS as part of the national Vascular Quality Initiative (VQI). We divided the patients based on presence or atrial arrythmia. We performed logistic regression analysis to identify the effect of atrial arrythmia on the combined endpoint of any stroke or death within 30 days after adjusting for adjusting for age, gender, severity of stenosis strata, and qualifying ischemic event type (asymptomatic, ischemic stroke, or transient ischemic attack). Results: A total of 1246 (14.1%) had atrial arrythmia among 8857 patients who underwent CAS. The proportion of patients who developed any stroke or death within 30 days was not different between patients with and those without atrial arrythmia (2.6% versus 2.5%, P=NS). The proportion of patients who developed any stroke within 30 days was not different between patients with and those without atrial arrythmia (1.9% versus 2.0%, P=NS). There were no differences in rates of myocardial infarction (0.3% versus 0.4%) or post procedural hematoma/bleeding (2.8% versus 2.4%). The proportion of patients who developed any stroke within 30 days was not different between symptomatic patients with and those without atrial arrythmia (1.9% versus 2.0%, P=NS). The odds ratio for any stroke or death within 30 days was not significantly different between patients with and those without atrial arrythmia (odds ratio OR 1.03, 95% confidence interval CI 0.71-1.54) after adjusting for potential confounders. Conclusion: Patients with atrial arrythmia can undergo CAS without any additional risk in regard to any stroke or death within 30 days in both asymptomatic and symptomatic patients with ICA stenosis.
Suri et al. (2026) studied this question. Atrial arrythmia did not increase the risk of stroke or death within 30 days after carotid stent placement, with an odds ratio of 1.03 (95% CI 0.71-1.54).
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