Association between increased superficial calcification clusters in carotid atherosclerosis and cardiovascular events after carotid artery stenting: A retrospective cohort study.

Background

The role of calcification in carotid atherosclerosis before and after carotid artery stenting (CAS) remains controversial. This study assessed the association between the extent of calcification in target carotid plaques and outcomes after CAS.

Methods

A total of 292 subjects with carotid stenosis who underwent CAS were retrospectively enrolled. Follow-up for major adverse cardiovascular events (MACEs) was conducted via outpatient visits and telephone. Ultimately, 211 subjects completed 2-year follow-up. Superficial calcification clusters were counted on CTA. Subjects with ≥4 superficial calcification clusters (n=24) were matched in a 1:4 ratio to those with <4 superficial calcification clusters (n=96). Sensitivity analysis was performed based on the matched cohort.

Results

Over a median follow-up of 1.92 years, 14 MACEs occurring more than 30 days after discharge were recorded. In univariate Cox analysis, symptom status (P= 0.0116), alcohol abuse (P= 0.0091), total number of calcification clusters (P= 0.0428), and number of superficial calcification clusters (P= 0.0022) were significantly associated with MACEs. In bivariate analyses, the number of superficial calcification clusters maintained a reasonably good association with MACEs. In sensitivity analysis, superficial calcification clusters remained significantly associated with MACE when loss to follow-up was classified as MACE (P= 0.0256, HR= 1.2548, 95% CI 1.0281-1.5315) or as no MACE (P= 0.0265, HR= 1.4948, 95% CI 1.0479-2.1323).

Conclusion

The number of superficial calcification clusters may independently serve as a prognostic risk factor in patients with carotid atherosclerosis undergoing CAS.