Silent brain infarcts after carotid or vertebrobasilar artery stenting
Jae-Chan Ryu1, Deok Hee Lee2, Jun Young Chang1
1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Insights
Vertebrobasilar stenting (VBS) leads to more silent brain infarcts (SBIs) than carotid artery stenting (CAS), particularly outside the stented area. Age is a key risk factor for VBS-related SBIs, while stent size and procedure time are critical for CAS.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Stenting is crucial for stroke prevention.
- Vertebrobasilar stenting (VBS) carries higher periprocedural risks.
- Silent brain infarcts (SBIs) predict future stroke events.
Purpose of the Study:
- To compare silent brain infarcts (SBIs) between VBS and CAS.
- To identify factors contributing to SBIs in VBS versus CAS.
- To understand anatomical differences influencing SBIs.
Main Methods:
- Retrospective analysis of patients undergoing elective VBS or CAS.
- Pre- and post-procedure diffusion-weighted imaging to detect new SBIs.
- Comparison of clinical variables, SBIs, and procedural factors between VBS and CAS groups.
Main Results:
- SBIs occurred more frequently in VBS (56.6%) compared to CAS (28.9%).
- SBIs outside the stented territory were higher in VBS (48.3%) than CAS (12.7%).
- Larger stents and longer procedures increased SBIs in CAS; only age increased SBIs in VBS.
Conclusions:
- VBS is associated with more SBIs, particularly remote ones, and longer procedures than CAS.
- SBIs after CAS are linked to stent size and procedural difficulty.
- Age is the primary predictor of SBIs following VBS, suggesting different pathomechanisms.
Background And Purpose:
Stenting is an important treatment for preventing stroke. However, the effect of vertebrobasilar stenting (VBS) might be limited because of relatively high periprocedural risks. Silent brain infarcts (SBIs) are known as a predictor for future stroke. Because of anatomical differences, factors for SBIs might be different between carotid artery stenting (CAS) and VBS. We compared the characteristics of SBIs between VBS and CAS.
Methods:
We included patients who underwent elective VBS or CAS. Diffusion-weighted imaging was performed pre- and post-procedure to detect new SBIs. Clinical variables, occurrence of SBIs, and procedure-related factors were compared between CAS and VBS. Moreover, we investigated predictors of SBIs in each group separately.
Results:
Ninety-two (34.2%) out of 269 patients had SBIs. SBIs were more frequently observed in VBS (29 [56.6%] vs. 63 [28.9%], p<.001). The risk of SBIs outside the stent-inserted vascular territory was higher in VBS compared to CAS (14 [48.3%] vs. 8 [12.7%], p<.001). Larger-diameter stents (odds ratio: 1.28, 95% confidence interval: 1.06-1.54, p = .012) and prolonged procedure time (1.01, [1.00-1.03], p = .026) increased the risk of SBIs in CAS, whereas only age increased the risk of SBIs in VBS (1.08 [1.01-1.16], p = .036).
Conclusions:
Compared to CAS, VBS was associated with longer procedure time, more residual stenosis, and more SBIs, especially outside the stent-inserted vascular territory. The risk of SBIs after CAS was associated with stent size and procedural difficulty. Only age was associated with SBIs in VBS. The pathomechanism of SBIs after VBS and CAS may be different.
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