Cerebral microemboli and neurocognitive change after carotid artery stenting with different embolic protection devices

Akkaya, Emre; Vuruşkan, Ertan; Gul, Zeynep Bastug; Yildirim, Aydın; Püşüroğlu, Hamdi; Surgit, Özgür; Kalkan, Ali Kemal; Akgül, Özgür; Akgul, Gamze Pinar; Gül, Mehmet

doi:10.1016/j.ijcard.2014.07.241

Cited by 28 publications

(17 citation statements)

References 35 publications

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“…Investigations by other groups suggest that microemboli do not have a long-term impact on cognition 9–10 . This present study found a decline in verbal learning memory at 1 month following intervention in patients with microemboli.…”

Section: Discussionmentioning

confidence: 98%

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Microembolization is associated with transient cognitive decline in patients undergoing carotid interventions

Hitchner

Baughman

Soman

et al. 2016

Journal of Vascular Surgery

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OBJECTIVE Carotid interventions are important in helping to reduce the risk of stroke for patients with high-grade carotid artery stenosis; however, incidence of subclinical cerebral microemboli can occur during these procedures. Previously, associations have been found between incidence of microemboli and postoperative decline in memory. We therefore sought to determine whether this decline persisted long-term and to assess changes in other cognitive domains. METHODS Patients were prospectively recruited under an IRB-approved protocol at a single academic center. Neuropsychological testing was administered preoperatively and at 1 month and 6 month intervals postoperatively. Cognitive domains that were evaluated included verbal memory, visual memory, psychomotor speed, dexterity, and executive function. Diffusion weighted MRI (DWI) sequencing was performed preoperatively and within 48 hours postoperatively to identify procedure-related microemboli. Univariate and multivariate regression models were used to identify relationships between microembolization, demographics, and cognition. RESULTS 80 patients were included; all were male and average age was 69 years. Forty patients underwent CAS and 40 CEA. 45% were diabetic, 50% had CAD, and 41% had prior neurologic symptoms. 45 (56%) of the patients had new postoperative microemboli. Microembolization was significantly more common in the CAS cohort (P<.005). Univariate analysis demonstrated that patients with procedure-related embolization showed decline 1 month postoperatively in verbal memory and Trail Making A measures. Multivariate analysis demonstrated that procedure-related embolization (OR: 2.8, P=.04) and pre-op symptomatic stenosis (OR: 3.2, P=.026) were independently predictors of decline for the RAVLT Short Delay measure at 1 month; however, at 6 months there was no significant relationship between emboli and decline on RAVLT Short Delay, while age (OR: 1.1, P=.005) and COPD (OR: 7.1, P=.018) were significantly associated with decline at 6 months following intervention. CONCLUSIONS Microembolization that is associated with carotid artery intervention predicts short-term cognitive decline. However, some of these cognitive deficits persist at 6 months following intervention, and further investigation is warranted to determine individual patient risk factors that may impact recovery.

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Section: Discussionmentioning

confidence: 98%

“…We have previously shown that patients with postoperative microemboli exhibit decline in verbal memory at 1 month following intervention 5 . Other studies have resulted in variable conclusions and the long-term effects of microemboli remain unclear 9–10 .…”

Section: Introductionmentioning

confidence: 99%

Microembolization is associated with transient cognitive decline in patients undergoing carotid interventions

Hitchner

Baughman

Soman

et al. 2016

Journal of Vascular Surgery

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“…In a study performed by Akkaya et al, neurocognitive tests were performed before and six months after CAS. Cerebral microembolism was not associated with neurocognitive decline . Similarly, a large retrospective registry did not support the association of new cerebral lesions with major adverse events at follow‐up .…”

mentioning

confidence: 84%

“…In our recent analysis, we compared the distal filter protection device (D‐EPD) to proximal balloon occlusion (P‐EPD). We also alluded to the same point the commentators mentioned demonstrating the advantage of P‐EPD had when looking into the six analyzed studies in regards to ischemic lesions on diffusion weighted‐magnetic resonance imaging (DW‐MRI) with no statistical differences in stroke incidence .…”

mentioning

confidence: 99%

Rebuttal regarding: Proximal occlusion versus distal filter for cerebral protection during carotid stenting: The positive results of MO.MA trials

Omran

Al-Dadah

White

2017

Cathet Cardio Intervent

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“…Евдокимовой, однако в данной работе высказано предположение, что решающее влияние на состояние когнитивных функций в отдаленном послеопера-ционном периоде оказывают исходные факторы сер-дечно-сосудистого риска и адекватность вторичной профилактики [52]. В то же время в нескольких ис-следованиях негативного влияния микроэмболиче-ских осложнений на состояние когнитивных функций показано не было [77,78].…”

Section: Endovascular Treatment Of Carotid Atherosclerosis эндоваскулunclassified

Endovascular Treatment of Carotid Atherosclerosis: Concerns and Perspectives

Tvorogova

Bulgakova

Шукуров

et al. 2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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1 Клиника «Семья». Россия 141730, Московская обл., Лобня, ул. Текстильная, 16 2 Государственный научно-исследовательский центр профилактической медицины Россия 101990, Москва, Петроверигский пер., 10Инсульт является одной из наиболее частых причин смерти и потери трудоспособности среди взрослого населения. Большинство ишемиче-ских инсультов обусловлено наличием атеросклеротического поражения внутренней сонной артерии. По сравнению с консервативной ме-дикаментозной терапией каротидная эндартерэктомия является более эффективной в профилактике инсультов у пациентов со стенозом сон-ной артерии. Стентирование сонной артерии также является широко распространенным методом лечения, однако, оно связано с большим количеством периоперационных осложнений. Знание факторов риска этих осложнений может повлиять на выбор тактики лечения пациен-та, однако эти факторы недостаточно изучены. Stroke is one of the most frequent causes of death and permanent disability among adults. The majority of ischemic strokes are due to atherosclerotic plaque in the internal carotid artery. Carotid endarterectomy is more effective than medical management in the prevention of stroke in patients with carotid artery stenosis. Carotid artery stenting, a less invasive revascularization strategy than endarterectomy, is also wide-spread but it is associated with more periprocedural complications. Knowledge of risk factors of these complications may impact treatment decisions for the individual patient, but these factors have not been extensively studied.Keywords: stroke, carotid artery disease, carotid angioplasty with stenting, complications, cerebral microemboli. ВведениеШирокое распространение нездорового образа жизни, с одной стороны, и успешная борьба с инфек-ционными заболеваниями, с другой, привели к тому, что основной задачей медицины начала XXI века ста-ла борьба с неинфекционными заболеваниями (НИЗ), ведущее место среди которых занимают болезни сер-дечно-сосудистой системы. В большинстве развитых стран мира острое нарушение мозгового кровообра-щения (ОНМК) лидирует среди причин нетрудоспо-собности взрослого населения и занимает второе или третье место в структуре смертности [1][2][3]. Несмотря на активное развитие системы оказания помощи больным с ОНМК, включающей тромболитическую, антикоагу-лянтную терапию и создание мультидисциплинарных бригад, краткосрочный и долгосрочный прогноз при ОНМК по-прежнему остается неблагоприятным. Это свя-зано как с высокой смертностью в острый период на-рушения мозгового кровообращения (в России -96-119 смертей на 100000 населения), так и с фор-мированием стойкой инвалидизации выживших боль-ных [2,4]. Таким образом, крайне актуальной остает-ся проблема разработки методов первичной и вто-ричной профилактики ОНМК. 80

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Cerebral microemboli and neurocognitive change after carotid artery stenting with different embolic protection devices

Cited by 28 publications

References 35 publications

Microembolization is associated with transient cognitive decline in patients undergoing carotid interventions

Microembolization is associated with transient cognitive decline in patients undergoing carotid interventions

Rebuttal regarding: Proximal occlusion versus distal filter for cerebral protection during carotid stenting: The positive results of MO.MA trials

Endovascular Treatment of Carotid Atherosclerosis: Concerns and Perspectives

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