A risk score to predict ischemic lesions after protected carotid artery stenting

Gröschel, Klaus; Ernemann, Ulrike; Schnaudigel, Sonja; Wasser, Katrin; Nägele, Thomas; Kastrup, Andreas

doi:10.1016/j.jns.2008.07.004

Cited by 35 publications

(21 citation statements)

References 23 publications

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“…We could observe some macroscopic debris in the aspirated blood from all patients with slow flow during CAS (Fig 1). The mean number of blood aspirations was 7.7 (range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17] in slow-flow cases. …”

Section: Resultsmentioning

confidence: 99%

“…6,11,12 Moreover, increased lesion load may be responsible for the clinical impact. 13,14 Lesion ulceration and masculine gender were significant factors helping in the prediction of flow impairment. Lesion ulceration was related to vulnerable plaque, which is an independent risk factor for stroke, 15 and can be detected by advanced assessment on ultrasonography or MRI.…”

Section: Discussionmentioning

confidence: 98%

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Significance of blood aspiration in carotid artery stenting with Angioguard XP

Mizobe

Nakamura

Motooka

et al. 2011

Journal of Vascular Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Significance of blood aspiration in carotid artery stenting with Angioguard XP

Mizobe

Nakamura

Motooka

et al. 2011

Journal of Vascular Surgery

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“…In a retrospective analysis of a subset of patients who received a DW-MRI, Gröschel et al 22 identified a risk score to predict ipsilateral ischemic lesions after protected stenting in a smaller group of patients including age, lesion ulceration, and lesion length >1 cm. The type of the aortic arch was not considered for the analysis, and patient selection may have caused a bias.…”

Section: Risk Factors For New Cerebral Ischemic Lesionsmentioning

confidence: 99%

Risk Factors for Cerebral Embolization After Carotid Artery Stenting With Embolic Protection

Bijuklic¹,

Wandler²,

Varnakov³

et al. 2013

Circ: Cardiovascular Interventions

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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.

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“…After CAS, age is reported to be one of the major risk factors of new ischemic brain lesions detected on DWI. 7) This study assessed the association of age and HI with new ischemic brain lesions using a binominal logistic regression analysis, and showed that both age and HI were significantly associated with the development of new ischemic brain lesions.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Instability Increases New Ischemic Brain Lesions on Diffusion-Weighted Imaging After Carotid Artery Stenting

Ito

Kato

Matsumura

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Hemodynamic instability (HI) may impair the washout of debris during distal intracranial circulation and increase the risk of clinically evident cerebral ischemia. However, the interaction between HI and new ischemic brain lesions detected on diffusion-weighted imaging (DWI) has not been examined. This study evaluated whether HI was significantly associated with the incidence of new ischemic brain lesions on DWI. Data on 128 patients who underwent carotid artery stenting (CAS) with the same devices and procedures between January 2005 and May 2010 were retrospectively analyzed. HI was noted in 31 (24.2%) patients. New ischemic brain lesions were detected on DWI in 25 (19.5%) patients. Ten of 31 (32.2%) patients with HI showed new ischemic brain lesions on DWI. Fifteen of 97 (15.5%) patients without HI showed new lesions. Univariate analysis showed that patients with HI had a significantly higher incidence of new ischemic brain lesions than patients without HI (p ＝ 0.04). A multivariable model showed that age and HI were significantly associated with the incidence of new ischemic brain lesions. In patients with carotid artery stenosis, decreased blood pressure produced no active vascular response, but reduced the cerebral blood volume and velocity due to impaired dynamic cerebral autoregulation. The results of this study suggest that HI with CAS induces impaired clearance of microembolisms and causes an increased number of new ischemic brain lesions detected on DWI.

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A risk score to predict ischemic lesions after protected carotid artery stenting

Cited by 35 publications

References 23 publications

Significance of blood aspiration in carotid artery stenting with Angioguard XP

Significance of blood aspiration in carotid artery stenting with Angioguard XP

Risk Factors for Cerebral Embolization After Carotid Artery Stenting With Embolic Protection

Hemodynamic Instability Increases New Ischemic Brain Lesions on Diffusion-Weighted Imaging After Carotid Artery Stenting

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