Carotid Artery Stenting in Symptomatic Carotid Stenosis With Chronic Kidney Disease: A Single-Center Retrospective Study

Objective: To investigate the short- and long-term event-free survival (EFS) in patients with chronic kidney disease (CKD) undergoing carotid artery stenting (CAS) for the treatment of symptomatic carotid artery stenosis. Method: The single-center retrospective study included 1363 patients, who were categorized into CKD stages 2, 3, 4, and 5 based on their glomerular filtration rate. The primary endpoint was long-term EFS from the occurrence of stroke, myocardial infarction (MI), or death within a 10-year follow-up period. Secondary outcomes included perioperative major adverse events, such as any stroke, MI, death, or transient ischemic attacks (TIAs) occurring within 30 days after CAS. Results: Perioperative event rates were 1.8%, 3.0%, 10.3%, and 8.7% across the 4 cohorts. The estimated rates of EFS were 96.1% versus 86.7% versus 78.4% versus 63.5% at 3 years, 91.0% versus 80.2% versus 65.2% versus 49.5% at 5 years and 78.0% versus 70.4% versus 54.8% versus 36.3% at 10 years. Kaplan-Meier analysis reported that the long-term EFS did not differ between patients with stage 2 and stage 3 CKD (107.79 months 95% confidence interval [CI]: 104.64, 110.95 vs 97.20 months, 95% CI, 90.71-103.69), whereas EFS was lower in patients with stage 4 and stage 5 CKD (67.04 months, 95% CI, 61.15-72.93 vs 58.56 months, 95% CI, 48.20-68.91) (log-rank P < .001). Conclusion: Patients with stage 2 to 3 CKD benefited from long-term EFS following invasive CAS. In contrast, those with stage 4 to 5 CKD exhibited poor long-term EFS or reduced life expectancy limiting the prevention of events over a 10-year follow-up period. Cautious consideration of the potential benefits was necessary when planning CAS even in symptomatic cases. Clinical Impact This study provided real-world 10-year follow-up evidence to refine CAS decision-making for symptomatic carotid stenosis patients with CKD. Clinicians could stratify candidates by CKD stages: stage 2-3 patients were recommended for CAS to gain satisfying long-term event-free survival, while for stage 4-5 patients, cautious, individualized benefit-risk assessment was required before intervention. The innovation lied in its large-sample, stage-stratified long-term outcome data filling the relevant gap in Chinese CKD population, guiding clinicians to avoid over-treatment for advanced CKD patients with limited life expectancy.