Impact of Additional Lipid-Lowering Therapy on New Ischemic Lesions of Diffusion-Weighted Imaging in Carotid Artery Stenting

Mizobe, Takashi; Nakamura, Mitsugu; Motooka, Yasuhiko; Ashida, Noriaki; Sugihara, Masahiro

doi:10.1016/j.jstrokecerebrovasdis.2017.10.009

Cited by 9 publications

(5 citation statements)

References 28 publications

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“…37 Statins are effective in preventing periprocedural complications 38,39 and in reducing brain lesions detected with magnetic resonance imaging diffusion-weighted image after CAS. 40 Short-term statin loading before CAS also reduced the incidence of 30-day ischemic cerebral events. 41 Recently, a systemic review covered the topic of carotid artery stenting and statin loading and summarized the beneficial effect of statin therapy in patients with CAS.…”

Section: Discussionmentioning

confidence: 96%

Neutrophil to Lymphocyte Ratio as a Predictor of Restenosis After Angioplasty and Stenting for Asymptomatic Carotid Stenosis

Dai

Zhao

et al. 2018

Angiology

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The inflammatory response plays a vital role in the development of in-stent restenosis (ISR) after carotid angioplasty and stenting (CAS). The neutrophil to lymphocyte ratio (NLR) has been suggested as a sensitive inflammatory marker. We explored the association between NLR and ISR in CAS patients. A total of 427 patients who underwent CAS were enrolled. Neutrophil to lymphocyte ratio was measured before the procedure. Clinical examination and radiographic evaluation were performed at 6 months and annually after the procedure. In-stent restenosis was defined as ≥50% stenosis in the treated lesion. Cox regression was used to identify predictors of ISR after CAS. Of the 459 arteries (in 427 patients) with CAS, 72 (15.7%) were identified with ISR during a mean follow-up of 14.6 (19.1) months (range, 0.7-120.7 months). Increased NLR (≥2.13) was significantly related to ISR in patients with asymptomatic stenosis ( P = .001). However, significance was not observed in symptomatic stenosis. On multivariate analysis, baseline NLR ≥ 2.13 (hazard ratio [HR], 2.74; 95% confidence interval [CI], 1.46-5.14), smoking (HR, 1.99; 95% CI, 1.11-3.58), residual stenosis (HR, 1.12; 95% CI, 1.09-1.15), and baseline glucose level (HR, 1.01; 95% CI, 1.01-1.02) were associated with ISR. Elevated NLR may be a predictor of ISR after CAS for asymptomatic stenosis.

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Section: Discussionmentioning

confidence: 96%

Neutrophil to Lymphocyte Ratio as a Predictor of Restenosis After Angioplasty and Stenting for Asymptomatic Carotid Stenosis

Dai

Zhao

et al. 2018

Angiology

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“…40 Administration of additional pre-procedural anticoagulants and additional lipid lowering therapy may be protective for development of new DWI lesions. 35,36,41 Another topic of interest is procedural timing in symptomatic patients. 37 As cerebrovascular events are more likely to occur in patients with unstable plaque, one could rationalise that timing of the procedure in symptomatic patients may influence the chance of dislodgement of plaque debris and therefore new DWI lesions, in line with research suggesting increased stroke risk after very urgent CEA.…”

Section: Discussionmentioning

confidence: 99%

Editor's Choice – Predictors of New Ischaemic Brain Lesions on Diffusion Weighted Imaging After Carotid Stenting and Endarterectomy: A Systematic Review

Rots

Meershoek

Bonati

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS STUDY ADDS This systematic review presents an overview of the available evidence on patient related features associated with an increased susceptibility to the development of new ischaemic brain lesions on magnetic resonance diffusion weighted imaging after carotid endarterectomy and carotid artery stenting. These demographic, radiological, and biochemical predictors may be helpful in decision making on patient selection for medical intervention, carotid stenting, or endarterectomy.Objectives: Peri-procedural ischaemic brain lesions on diffusion weighted imaging (DWI) after carotid endarterectomy (CEA) and carotid artery stenting (CAS) have been related to a higher chance of recurrent cerebrovascular events. This systematic review provides an overview of patient characteristics associated with increased risk of new DWI lesions. Methods: MEDLINE, EMBASE, and Cochrane library databases were systematically searched (update November 2018) for studies reporting post-procedural DWI lesions after CEA or CAS. Data derived from both procedures were analysed separately. Studies reporting predictive features that were present prior to intervention were assigned to 10 categories: age, gender, cardiovascular risk factors, symptomatology, plaque vulnerability, atherosclerotic burden, cerebrovascular haemodynamics, carotid/arch anatomy, inflammatory markers, and markers of coagulation. A semi-quantitative analysis was performed by plotting studies that found an association between the investigated features and DWI lesions against those that did not find an association. Results: Forty-six studies (5018 patients) were included: 10 reported only CEA, 33 CAS, and three both interventions. 68.0% of 1873 CEA patients and 55.9% of 3145 CAS patients were symptomatic. The weighted prevalence of DWI lesions was 18.1% (95% CI 14.0e22.7%) in CEA patients compared with 40.5% (95% CI 35.4e45.7%) in CAS patients. Studies reporting on CEA patients predominantly found an increased risk in symptomatic patients (two of seven studies, including 848/1661 patients), those with impaired haemodynamics (five of five studies), and increased inflammatory markers (two of three studies). Studies reporting on CAS patients often found a positive association with age (10/26 studies), high plaque vulnerability (25/34 studies), or complex carotid/arch anatomy (three out of five studies). Conclusions: For patients undergoing CEA, symptomatic status, impeded cerebral haemodynamics, and increased inflammatory markers are associated with increased susceptibility to peri-operative DWI lesions. In CAS patients, higher age, plaque vulnerability and complex carotid/aortic arch anatomy were identified as risk factors. These clinical predictors may assist with decision making on patient selection for medical treatment, CEA or CAS.

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“…53 The addition of a PCSK9 inhibitor to statin therapy appears to have a beneficial effect in patients undergoing CAS. 54 Patients initiated on a PCSK9 inhibitor (besides their standard statin treatment) before undergoing CAS had a significant reduction in new ischemic lesions on diffusion-weighted imaging compared with patients only receiving standard statin treatment (11.5 vs 41.2%, respectively; p = 0.029). 54 Preliminary evidence suggests that preoperative administration of PCSK9 inhibitors stabilize carotid plaques and reduce perioperative complications in patients undergoing CAS.…”

Section: Drawbacks Associated With Statin Usementioning

confidence: 91%

“…54 Patients initiated on a PCSK9 inhibitor (besides their standard statin treatment) before undergoing CAS had a significant reduction in new ischemic lesions on diffusion-weighted imaging compared with patients only receiving standard statin treatment (11.5 vs 41.2%, respectively; p = 0.029). 54 Preliminary evidence suggests that preoperative administration of PCSK9 inhibitors stabilize carotid plaques and reduce perioperative complications in patients undergoing CAS. 55 The beneficial effects of PCSK9 inhibitors on carotid plaque composition and regression will be investigated in the on-going CARotid plaqUe StabilizatiOn and regression with evolocumab (CARUSO) study.…”

Section: Drawbacks Associated With Statin Usementioning

confidence: 91%

Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease

Paraskevas¹,

Gloviczki

Antignani³

et al. 2022

Progress in Cardiovascular Diseases

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Impact of Additional Lipid-Lowering Therapy on New Ischemic Lesions of Diffusion-Weighted Imaging in Carotid Artery Stenting

Cited by 9 publications

References 28 publications

Neutrophil to Lymphocyte Ratio as a Predictor of Restenosis After Angioplasty and Stenting for Asymptomatic Carotid Stenosis

Neutrophil to Lymphocyte Ratio as a Predictor of Restenosis After Angioplasty and Stenting for Asymptomatic Carotid Stenosis

Editor's Choice – Predictors of New Ischaemic Brain Lesions on Diffusion Weighted Imaging After Carotid Stenting and Endarterectomy: A Systematic Review

Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease

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