Predictors of Periprocedural Brain Lesions Associated with Carotid Stenting

Abstract

Background: Carotid stenting carries a risk of periprocedural stroke. We aimed at determining predictors of cerebral ischemic events associated with stenting for symptomatic carotid stenosis. Methods: 127 patients who had been studied by diffusion-weighted MR imaging (DWI) before and on the day after carotid stenting were included. Six clinical variables and 5 variables characterizing the target carotid artery and aortic atherosclerosis were analyzed as potential risk factors for new ipsilateral DWI lesions after stenting. Results: Among all variables assessed, only age, length of stenosis and carotid intima-media thickness (IMT) significantly modified the risk of new lesions after stenting. Age ≧68 years, stenosis ≧15 mm and IMT ≧1.3 mm were identified as the best thresholds to predict new lesions. In the subgroup of patients ≧68 years with carotid stenosis ≧15 mm in length and IMT ≧1.3 mm, the risk of new lesions was markedly higher than in patients to whom no more than two of these factors applied (odds ratio 7.250, 95% CI 1.612–34.513, p = 0.005). The use of this simple predictive model correctly identified patients who had new lesions after stenting with high specificity (0.96) and a negative predictive value (0.83), while the positive predictive value was moderate (0.60) and sensitivity was low (0.23). Conclusions: The risk of stenting for symptomatic carotid stenosis may vary with clinical and morphological patient characteristics. Further research is needed to validate these results and to evaluate the safety of stenting versus endarterectomy in specific patient subgroups.

Effect of Pitavastatin on Preventing Ischemic Complications with Carotid Artery Stenting: A Multicenter Prospective Study—EPOCH-CAS Study

“…In our study, there was a significant difference in LDL-C and total cholesterol levels between the two groups. However, several authors reported that dyslipidemia or hyperlipidemia did not affect the post-CAS DWI-positive lesion occurrence [19,21]. Our study also revealed that an independent factor for post-CAS new DWI-positive lesions was pitavastatin treatment, but not LDL-C level.…”

“…Several investigators, using DWI to detect clinically silent embolic lesions after protected CAS, have reported new DWI lesions at frequencies of 6.7-73 % [8,[17][18][19][20][21]. A substudy of the International Carotid Stenting Study (ICSS) reported that new DWI lesions occurred in 62 of 124 patients (50 %) in the stenting group [18].…”

Characteristics of Ischemic Brain Lesions After Stenting or Endarterectomy for Symptomatic Carotid Artery Stenosis

“…Another study found no association between history of diabetes mellitus and increased occurrence of DWI lesions after CAS. 10,11 In 1 nonrandomized study, diabetes mellitus was a predictor of perioperative stroke or death in CEA patients (RR, 2.83; 95% CI, 1.05-7.61; P=0.04) but not in CAS patients (P=0.72).…”

Endovascular Treatment of Carotid Atherosclerosis: Concerns and Perspectives

“…Пре-дикторами развития микроэмболических осложне-ний, по данным другого исследования, служат возраст ≥68 лет, протяженность бляшки ≥15 мм, а также тол-щина комплекса интима-медиа ≥1,3 мм. Сочетание всех трех указанных факторов повышает риск развития эм-болических осложнений в 7 раз по сравнению с паци-ентами, у которых присутствуют два и менее признаков [56]. По данным A. Rostamzadeh и соавт.…”