Distal normal vessel diameter might be associated with silent brain infarcts after stenting for symptomatic carotid stenosis.

Autor: Ryu JC; Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea., Lee SH; Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea., Kwon B; Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Song Y; Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Lee DH; Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Kim BJ; Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Kang DW; Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Kwon SU; Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Kim JS; Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea., Chang JY; Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: noyerpapa@gmail.com.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2024 Jul; Vol. 125, pp. 1-6. Date of Electronic Publication: 2024 May 09.
DOI: 10.1016/j.jocn.2024.05.001
Abstrakt: Background: Carotid artery stenting (CAS) has been the standard treatment for carotid stenosis because it is less invasive; however, the risk of periprocedural thromboembolism is high. We investigated the predictors for silent brain infarcts (SBIs), focusing on embolic protection in CAS.
Methods: This study was single-center retrospective study, and we obtained baseline demographics and clinical, laboratory, and periprocedural variables of patients who underwent CAS. Also, methods used for embolic protection (no EPD, distal EPD, or proximal balloon guiding catheter) during CAS were obtained. Distal normal vessel diameter was defined as the diameter of cervical internal carotid artery where the artery wall becomes parallel. Diffusion-weighted imaging was performed before and after procedure to detect SBIs. The primary outcome was stented territory SBIs, and the secondary outcomes were any territories SBIs and stented territory SBIs in cases with EPD.
Results: A total of 196 CAS procedures with mean age 69.1 ± 9.9 years were included. After CAS, stented territory SBIs occurred in 53 (27.0 %) cases and any territories SBIs in 60 (30.6 %) cases. Univariable analyses revealed that distal normal vessel diameter (odds ratio = 1.71, 95 % confidence interval = 1.20-2.43, P = 0.003) was associated with the occurrence of stented territory SBIs after CAS. After adjusting for potential variables, larger distal normal vessel diameter (1.61 [1.10-2.36], P = 0.014) increased the occurrence of SBIs after CAS. Consistent results were obtained when the outcome was any territories SBIs or stented territory SBIs in cases with EPD.
Conclusions: Distal normal vessel diameter was a predictor for the occurrence of SBI after CAS. The passable pore size of EPDs may vary depending on vessel diameter, and may impact the occurrence of SBIs.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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