The effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures (from the COMPLEX-CAS Trial)
BACKGROUND: Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures.
METHODS: We prospectively evaluated 122 patients (mean age: 69.5 ± 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients.
RESULTS: Among the study population, 32 patients (26.2%) had SNICLs. The DWI-positive group had a significantly higher common carotid artery (CCA)-internal carotid artery (ICA) angle, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI-negative group. High CCA-ICA angle was identified as one of the independent predictors of SNICL (OR (odds ratio) = 1.103 95%CI (confidence interval): (1.023-1.596); p = 0.034), and CCA-ICA angle higher than 34.5 degrees predicted SNICL with a sensitivity of 62.5% and a specificity of 62.2% (area under the curve: 0.680; 95% CI: 0.570 to 0.789; p = 0.003).
CONCLUSIONS: The higher CCA-ICA angle may predict pre-procedure SNICL risk in carotid artery stenting and may have clinical value in the management of patients with carotid artery stenosis.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Vascular - 30(2022), 2 vom: 07. Apr., Seite 292-300 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Güner, Ahmet [VerfasserIn] |
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| Links: |
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| Themen: |
Carotid artery |
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| Anmerkungen: |
Date Completed 06.04.2022 Date Revised 06.04.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1177/17085381211010016 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM324498497 |
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| 245 | 1 | 4 | |a The effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures (from the COMPLEX-CAS Trial) |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures | ||
| 520 | |a METHODS: We prospectively evaluated 122 patients (mean age: 69.5 ± 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients | ||
| 520 | |a RESULTS: Among the study population, 32 patients (26.2%) had SNICLs. The DWI-positive group had a significantly higher common carotid artery (CCA)-internal carotid artery (ICA) angle, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI-negative group. High CCA-ICA angle was identified as one of the independent predictors of SNICL (OR (odds ratio) = 1.103 95%CI (confidence interval): (1.023-1.596); p = 0.034), and CCA-ICA angle higher than 34.5 degrees predicted SNICL with a sensitivity of 62.5% and a specificity of 62.2% (area under the curve: 0.680; 95% CI: 0.570 to 0.789; p = 0.003) | ||
| 520 | |a CONCLUSIONS: The higher CCA-ICA angle may predict pre-procedure SNICL risk in carotid artery stenting and may have clinical value in the management of patients with carotid artery stenosis | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Carotid artery | |
| 650 | 4 | |a diffusion-weighted imaging | |
| 650 | 4 | |a silent new ischemic cerebral lesions | |
| 650 | 4 | |a stenting | |
| 700 | 1 | |a Çelik, Ömer |e verfasserin |4 aut | |
| 700 | 1 | |a Topel, Çağdaş |e verfasserin |4 aut | |
| 700 | 1 | |a Arif Yalçın, Ahmet |e verfasserin |4 aut | |
| 700 | 1 | |a Kalçık, Macit |e verfasserin |4 aut | |
| 700 | 1 | |a Uzun, Fatih |e verfasserin |4 aut | |
| 700 | 1 | |a Altunova, Mehmet |e verfasserin |4 aut | |
| 700 | 1 | |a Örten, Murat |e verfasserin |4 aut | |
| 700 | 1 | |a Akman, Cemalettin |e verfasserin |4 aut | |
| 700 | 1 | |a Güner, Ezgi Gültekin |e verfasserin |4 aut | |
| 700 | 1 | |a Ertürk, Mehmet |e verfasserin |4 aut | |
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