Impact of Diabetes Mellitus on Outcome of Patients Undergoing Carotid Artery Stenting: Insights From a Single Center Registry Hitinder S. Gurm, 1 * MD, Vivek Rajagopal, 2 MD, Ravish Sachar, 3 MD, Alex Abou-Chebl, 2 MD, Samir R. Kapadia, 2 MD, Chris Bajzer, 2 MD, FACC, and Jay S. Yadav, 4 MD, FACC Objective: To evaluate the impact of diabetic status on outcome of patients under- going carotid artery stenting (CAS). Background: Diabetes has been demonstrated to be a strong predictor of adverse outcome in patients undergoing coronary revasculari- zation. Its significance in predicting outcome of patients undergoing carotid interven- tions 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 analy- sis was 30 day incidence of stroke, myocardial infarction, and death. Results: Diabetes was present in 311 patients. Baseline characteristics were comparable between dia- betics 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 protec- tion device. Diabetes was not a risk factor for adverse outcome after CAS after multi- variate 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. Key words: diabetes; carotid artery stenting; emboli protection devices INTRODUCTION Diabetes is a major health problem with the num- bers of diabetics increasing both in the United States and globally. Cardiovascular disease is the leading cause of mortality and morbidity in the diabetic popu- lation [1]. When compared with nondiabetics, diabetics have a worse outcome after cardiovascular therapeutic interventions [2–4]. Diabetes is a major risk factor for stroke [5] and diabetics make up 11%–40% of patients undergoing carotid endarterectomy (CEA) [4]. Further, diabetes appears to be a major predictor of adverse outcome in this population [6]. Recently carotid artery stenting (CAS) has emerged as a viable alternative to CEA [7]. The impact of dia- betes on outcome of patients undergoing CAS remains unknown. We accordingly evaluated the short and long term outcome of diabetic patients undergoing CAS at our institution. All work presented in this analysis was performed at the Cleve- land Clinic Foundation. 1 Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 2 Cleveland Clinic Foundation, Cleveland, Ohio 3 Wake Heart and Vascular Associates, Raleigh, North Carolina 4 Cleveland, Ohio *Correspondence to: Hitinder S. Gurm, MBBS, Division of Cardio- vascular Medicine, University of Michigan, TC B1-226, 1500 E Medical Ctr Drive, Ann Arbor, MI 48109-0311, USA. E-mail: hgurm@med.umich.edu Received 19 September 2006; Revision accepted 26 October 2006 DOI 10.1002/ccd.21020 Published online 8 February 2007 in Wiley InterScience (www. interscience.wiley.com). ' 2007 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 69:541–545 (2007)