Risk factors for cerebral embolization after carotid artery stenting with embolic protection: a diffusion-weighted
Klaudija Bijuklic1, Andreas Wandler, Yuriy Varnakov
1Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany.
Insights
Age, hypertension, lesion characteristics, and aortic arch anatomy predict new brain lesions after carotid artery stenting (CAS). These factors also influence bilateral lesions, impacting patient treatment decisions.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Cardiology
Background:
- Carotid artery stenting (CAS) carries a periprocedural stroke risk, potentially varying by patient subgroup.
- Risk factors for cerebral embolic lesions during CAS require further investigation to guide individual treatment.
- Identifying predictors of cerebral ischemia during CAS is crucial for patient management.
Purpose of the Study:
- To identify factors predicting cerebral ischemic lesions during embolic-protected CAS.
- To analyze predictors for new ischemic lesions and bilateral lesions after CAS.
Main Methods:
- Prospective evaluation of 837 patients undergoing CAS with cerebral embolic protection.
- Pre- and post-procedural diffusion-weighted magnetic resonance imaging (DW-MRI) for lesion detection.
- Multivariable logistic regression to identify predictive factors for embolic lesions.
Main Results:
- New ischemic lesions occurred in 32.8% of patients.
- Predictive factors for lesions included age, hypertension, lesion length, eccentricity, and aortic arch type III. Calcified lesions showed a negative association.
- Bilateral lesions were associated with age, contralateral carotid stenosis (>50%), and aortic arch type II/III.
Conclusions:
- Age, hypertension, lesion morphology, and aortic arch type predict procedural cerebral embolic lesions during CAS.
- Age, contralateral stenosis, and complex aortic arch anatomy predict bilateral ischemic lesions.
- The clinical significance of these embolic lesions warrants further research.
Background:
Meta-analyses of randomized trials have shown an increased risk of periprocedural stroke after carotid artery stenting (CAS) compared with carotid endarterectomy, which may differ in specific patient subgroups. Knowledge of risk factors for cerebral embolic lesions during CAS may impact treatment decisions for the individual patient, but these factors have not been extensively studied. We aimed to identify factors predictive for cerebral ischemic lesions during embolic protected CAS.
Methods And Results:
Preprocedural and postprocedural diffusion-weighted magnetic resonance imaging was performed for evaluation of new cerebral ischemic lesions in 728 (86.9%) of 837 consecutive patients undergoing CAS with cerebral embolic protection. Multivariable logistic regression analyses were performed to identify factors predictive for embolic lesions. New ischemic lesions were found in 32.8% of patients. Age, hypertension, lesion length, lesion eccentricity, and aortic arch type III were significantly associated with new ischemic lesions; calcified lesions were negatively associated. In 25% of these patients embolic lesions were also found in the contralateral hemisphere. Predictive factors for contralateral lesions were age, >50% stenosis of the contralateral internal carotid artery, and an aortic arch type II, with a trend for aortic arch type III.
Conclusions:
Age, hypertension, lesion morphology, and aortic arch type were predictive for procedural-related cerebral embolic lesions during embolic protected CAS. Age, significant contralateral carotid stenosis, and complex aortic arch type were predictive for bilateral ischemic lesions. The clinical implications of ischemic lesions are not yet fully understood.
