P-012 Carotid artery stenting outcomes by neurointerventional surgeons (CASONI)

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Background Multiple studies have highlighted the importance of carotid artery stenting (CAS) operator’s experiences. However, fellowship-trained neurointerventionalists (NIRs) remain an under-represented specialty in the literature. We aim to report the complication rate of CAS performed exclusively by NIRs. Methods Retrospective cohort study regarding stenting symptomatic and asymptomatic carotid stenosis was collected at multiple comprehensive stroke centers (CSCs). The primary outcome included a composite of the 30-day periprocedural mortality, symptomatic ischemic stroke, symptomatic intracranial hemorrhage (sICH), and myocardial infarction (MI). The secondary outcomes included other complications. Chi-squared tests were performed for categorical variables, and Welch’s t-test was used for continuous variables. Cutoffs in continuous variables were estimated using grid search optimization. Sensitivity analyses were performed for missing data. Results Between 2018 and 2022, 1445 CAS procedures were performed by 38 NIRs. We have 30 day outcome data on 1281 patients. Patients were predominantly symptomatic (93.01%), male (65.79%), white (70.36%), and had a median age of 69. The primary outcomes occurred in 26 (1.8%) cases, with 13 (0.9%) death, 8 (0.55%) symptomatic ischemic stroke, 4 (0.28%) sICH, and 1(0.07%) MI. A statistically significant increase in all outcomes correlated with advanced age (P=0.001), women (P=0.013), aortic arch type 3 (P=0.01), and higher preprocedural mRS (P=0.006). Secondary outcomes were higher in Hispanic and African American patients (P=0.007) and those with low diastolic blood pressure (DBP) at stenting (P=0.04). Conclusions CAS, conducted by fellowship-trained NIR physicians in CSCs, demonstrates a lower complication rate than what was previously reported in CAS, carotid endarterectomy (CEA), and transcarotid artery revascularization (TCAR) literature. Physician training, higher frequency, and standardized stroke care in a CSC may contribute to this low complication rate. Disclosures M. Ezzeldin: 3; C; Viz AI. and Imperative care. 4; C; Galaxy therapeutics. A. Hassan: 2; C; Medtronic, Microvention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera therapeutics, Proximie, NeuroVasc, NovaSignal, Vesalio, Rapid Medical, Imperative Care,. 6; C; Principal Investigator: COMPLETE study – Penumbra, LVO SYNCHRONISE – Viz.ai, Millipede Stroke Trial - Perfuze, RESCUE - ICAD - Medtronic. Steering Committee/Publication committee member: SELECT, DAWN,. A. Kerro: None. M. Martucci: None. M. Hussain: None. O. Mir: None. F. Sherrif: None. P. Kan: 2; C; Stryker. C. Ezepue: None. N. Janjua: None. K. Asif: None. R. Grandhi: None. A. Alaraj: 2; C; Cerenovus. M. Niazi: None. O. Mansour: None. M. Chen: None. S. Bushnaq: None. O. Tanweer: 2; C; Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc., Q’Apel Inc. Proctor: Microvention Inc, Medtronic Inc. A. Delora: None. R. Ezzeldin: None. B. Navpreet: None. V. Chaubal: None. M. Abdulrazzak: None. H. Saei: None. G. Rodriguez: None. M. AlMajali: None. G. Edhayan: None. A. Shekhlee: None. C. Hadjialiakbari: None. M. Froukh: None. W. Salah: None. E. Nico: None. A. Madapoosi: None. Y. Radiaideh: None. D. Quispe-Orozco: None. O. Haim: None. N. Garza: None. A. Maud: None. M. Rolon-Newton: None. B. Barakat: None. T. Gowda: None. M. Monk: None. Z. Ali: None. T. Anwoju: None. O. Zaidat: None. F. Siddiq: None.

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