Impact of diabetes mellitus on outcome of patients undergoing carotid artery stenting: Insights from a single center registry All work presented in this analysis was performed at the Cleveland Clinic Foundation.

Objective : To evaluate the impact of diabetic status on outcome of patients undergoing carotid artery stenting (CAS). Background : Diabetes has been demonstrated to be a strong predictor of adverse outcome in patients undergoing coronary revascularization. Its significance in predicting outcome of patients undergoing carotid interventions has not been ascertained. Methods : We evaluated the short-term outcomes of 833 patients who underwent CAS at our institution. The primary outcome of this analysis was 30 day incidence of stroke, myocardial infarction, and death. Results : Diabetes was present in 311 patients. Baseline characteristics were comparable between diabetics and nondiabetics except for the diabetics having a lower left ventricular ejection fraction, lower hemoglobin, and a higher body mass index at baseline. Further, they were more likely to have congestive heart failure and coronary artery disease. There was no difference in the incidence of stroke (1.9% versus 2.7%,), myocardial infarction (MI) (2.6% versus 1.9%), death (3.9% versus 2.5%), or the composite of death stroke or MI (6.8% versus 5.9%) at 30 days between diabetics and nondiabetics. Similar results were seen when the analysis was restricted to patients treated with an emboli protection device. Diabetes was not a risk factor for adverse outcome after CAS after multivariate adjustment. Conclusion : Diabetics undergoing CAS are more likely to have associated co-morbidities. However despite this handicap, their short term outcome after CAS is similar to that of nondiabetics. © 2007 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55973/1/21020_ftp.pd

An International, Multispecialty, Expert-Based Delphi Consensus Document on Controversial Issues in the Management of Patients with Asymptomatic and Symptomatic Carotid Stenosis

Objective: Despite the publication of various national/international guidelines, several questions concerning the management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis remain unanswered. The aim of this international, multi-specialty, expert-based Delphi Consensus document was to address these issues to help clinicians make decisions when guidelines are unclear. Methods: Fourteen controversial topics were identified. A 3-round Delphi Consensus process was performed including 61 experts. The aim of Round 1 was to investigate the differing views and opinions regarding these unresolved topics. In Round 2, clarifications were asked from each participant. In Round 3, the questionnaire was re-sent to all participants for their final vote. Consensus was reached when ≥75% of experts agreed on a specific response. Results: Most experts agreed that: (i) the current periprocedural/in-hospital stroke/death thresholds for performing a carotid intervention should be lowered from 6 to 4% in SxCS and from 3 to 2% in AsxCS patients, (ii) the time threshold for a patient being considered "recently symptomatic" should be reduced from the current definition of "6 months" to 3 months or less, (iii) 80-99% AsxCS carries a higher risk of stroke compared with 60-79% AsxCS, (iv) factors beyond the grade of stenosis and symptoms should be added to the indications for revascularization in AsxCS patients (e.g., plaque features of vulnerability and silent infarctions on brain CT scans), and, (v) shunting should be used selectively, rather than always or never. Consensus could not be reached on the remaining topics due to conflicting, inadequate, or controversial evidence. Conclusions: The present international, multi-specialty expert-based Delphi Consensus document attempted to provide responses to several unanswered/unresolved issues. However, consensus could not be achieved on some topics, highlighting areas requiring future research