Incidence and predictors of acute kidney injury in patients undergoing proximal protected carotid artery stenting

Aims: Many studies have analysed the occurrence of acute kidney injury (AKI) after percutaneous coronary intervention (PCI) but there are limited data relating to AKI risk in patients undergoing carotid artery stenting (CAS). The aim of this study was to determine the incidence and predictors of AKI in patients undergoing proximal protected CAS. Methods and results: We analysed 456 patients undergoing proximal protected CAS. A binomial multivariate logistic model was developed including patients clinical and angiographic/procedural characteristics. AKI (defined as an sCr increase >= 0.3 mg/dl or >= 1.5-fold sCr increase from baseline or more than 50% increase from baseline, within 48 hours post procedure) occurred in 155 patients (34%). AKI patients were more frequently affected by hypertension, diabetes, dyslipidaemia and anaemia, and presented lower renal function at baseline. Higher contrast volume to creatinine clearance ratio (2.40 +/- 1.44 vs. 2.08 +/- 1.15; p=0.01), lower post-procedural mean arterial pressure (MAP) (94.3 +/- 17.7 vs. 99.6 +/- 18.5 mmHg; p=0.003) and a more frequent post-procedural systolic pressure drop (Delta SBP > 50 mmHg) (23.9% vs. 14.3%, p=0.01) were observed in the AKI group of patients. At multivariate analysis, independent predictors of AKI were Delta SBP > 50 mmHg, diabetes mellitus and dyslipidaemia. Conclusions: AKI can occur quite frequently after proximal protected CAS and is related to clinical and procedural features. These data should be confirmed in larger registries or randomised trials.