Evaluation of silent brain injury in patients undergoing aorto-ostial coronary stent implantation
Ufuk Yildirim1, Abdulkadir Kara1, Muhammet Uyanik2
1Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
Insights
Aorto-ostial stenting may increase silent brain injury (SBI) risk, especially with significant stenosis. Longer procedure times also predict SBI development in patients undergoing AO stent implantation.
Area of Science:
- Cardiology
- Neurology
- Interventional Cardiology
Background:
- Aorto-ostial (AO) coronary interventions carry risks, including atherothrombotic debris embolization.
- Embolization may lead to stroke or silent brain injury (SBI).
- The study investigates the association between AO stenting and increased SBI risk.
Purpose of the Study:
- To determine if AO stent implantation increases the risk of silent brain injury (SBI).
- To identify predictors of SBI in patients undergoing AO stenting.
Main Methods:
- Compared 55 patients undergoing AO stenting with 55 undergoing non-AO stenting.
- Measured neuron-specific enolase (NSE) levels pre- and post-procedure as a marker of brain injury.
- Defined SBI as newly developed NSE elevation in asymptomatic patients.
Main Results:
- SBI detected in 43.6% of AO stenting patients vs. 30.9% of non-AO stenting patients (p=.167).
- Significant AO stenosis (≥50%) independently predicted SBI (OR 2.856, p=.038).
- Longer procedure time also independently predicted SBI (OR 1.037, p=.023).
Conclusions:
- AO stenting may be linked to a higher risk of SBI.
- Significant ostial lesions are a key predictor of SBI in this context.
Background:
Aorto-ostial (AO) coronary interventions may be associated with multiple problems, including the potential embolization of atherothrombotic debris into the aorta and systemic circulation. Such embolization could theoretically lead to stroke or silent brain injury (SBI). In this study, we aimed to investigate whether there is an increased risk of SBI in patients undergoing AO stent implantation.
Methods:
Fifty-five consecutive patients undergoing AO stenting and 55 consecutive patients undergoing non-AO stenting were included. Venous blood samples were obtained before and 12 h after the procedure to measure neuron-specific enolase (NSE), which is a sensitive marker of brain injury. Newly developed NSE elevation after the procedure in an asymptomatic patient was defined as SBI.
Results:
SBI was detected in 24 (43.6%) patients in the AO stenting group and 17 (30.9%) patients in the non-AO stenting group (p = .167). Although the SBI rates were statistically comparable between the groups, the presence of significant (≥50%) AO stenosis was found to be an independent predictor of SBI in multivariate logistic regression analysis [odds ratio (OR) 2.856; 95% confidence interval (CI) 1.057-7.716; p = .038]. A longer procedure time was another independent predictor for the development of SBI (OR 1.037; 95% CI 1.005-1.069; p = .023).
Conclusion:
This study suggests that AO stenting may be associated with an increased risk of SBI if the lesion in the ostium is significant.
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