Risk factors associated with microembolization after carotid intervention

Area of Science:

• Vascular Surgery
• Neurology
• Radiology

Background:

• Microembolization is a known complication of carotid artery stenting (CAS) and carotid endarterectomy (CEA).
• Patients undergoing CAS are recognized to have a higher propensity for microembolization.
• Procedure-related microemboli may contribute to neurocognitive impairment.

Purpose of the Study:

• To prospectively compare microembolization rates between CAS and CEA.
• To identify perioperative characteristics associated with microembolization in patients undergoing CAS and CEA.

Main Methods:

• Prospective cohort study involving 202 patients (107 CAS, 95 CEA).
• 3T brain MRI with diffusion-weighted imaging used pre- and post-procedure to detect new embolic lesions.
• Logistic regression analysis applied to assess risk factors for embolization.

Main Results:

• Higher microembolization rates observed in CAS patients (78%) compared to CEA patients (27%) (P < .0001).
• For CAS, independent risk factors for embolization included external carotid artery patency (OR, 11.4), lesion calcification (OR, 5.68), and lesion length (OR, 0.29).
• These specific risk factors did not increase embolization risk in CEA patients.

Conclusions:

• Carotid artery stenting is associated with a significantly higher risk of perioperative embolization.
• Lesion length and calcification are critical preoperative factors influencing embolization risk in CAS.
• Identifying these risk factors can aid in patient selection to mitigate neurocognitive impairment from embolization.