Definitions of high-risk patients
| Anatomic Risk Factors | Comorbidity Risk Factors | |
|---|---|---|
| Group A | Group B | |
| Previous carotid endarterectomy | Patients >80 years of age | NYHA class III or IV heart failure |
| Contralateral carotid artery occlusion | ||
| Previous radical neck dissection or radiation therapy to neck region | MI within previous 6 weeks | |
| Target lesion above C2 (level of jaw) | COPD with FEV1 <30% predicted | |
| Low cervical carotid lesions | ||
| Dissection | Unstable angina (according to Braunwald classification) | |
| Inability to extend neck (ie, cervical osteoarthritis, mobility limitations) | History of liver failure with elevated prothrombin time | |
| Tandem lesions ≥70% stenosis | Elective CABG scheduled minimally 30 days after the carotid stenting procedure | |
| Contralateral laryngeal palsy | ||
| At risk for wound infection | ||
| Tracheostomy | Severe renal failure defined as a serum creatine >2 mg/dL | |
Note:—Patients are at high risk if they have (1) one or more anatomic risk factors, (2) one co-morbidity (group A) risk factor, or (3) one or more co-morbidity (group B) risk factors. NYHA indicates New York Heart Association; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; CABG, coronary artery bypass grafting.