Impact of Frailty on Medium-Term Outcome in Asymptomatic Patients After Carotid Artery Stenting.

OBJECTIVE: There are few reports on the relationship between carotid artery stenting (CAS) and frailty. In this study, medium-term outcome after CAS in patients with asymptomatic carotid artery stenosis was examined to see the effect of frailty itself. METHODS: A retrospective study was performed in 71 consecutive patients who were treated with CAS for asymptomatic lesions from January 2007 to June 2014. In this study, only patients without neurologic symptoms before treatment were included. Frailty was defined on the basis of the presence of ≥2 of the 5 items on the Cardiovascular Health Study (CHS) Index. The relationship of frailty with a composite endpoint of the incidence of stroke, disease requiring hospital admission, and death for 3 years after CAS was examined. RESULTS: There were 23 cases (average age 73.9 years, median CHS index 3) with frailty and 48 (average age 70.9 years, median CHS index 0) without frailty. There were no differences in comorbidities or CAS perioperative complications between these groups. However, there was a significantly higher incidence of the composite endpoint in patients with frailty (13/23 vs. 4/48, P < 0.001), and in multivariate analysis, frailty was strongly associated with this endpoint (odds ratio 28.24, 95% confidence interval 4.62-172.71). CONCLUSIONS: In CAS conducted for asymptomatic lesions, perioperative complications had no relationship with frailty. However, frailty is likely to be associated with lower activity of daily life in the medium term after CAS, and consideration of underlying diseases is required in patients with frailty.