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THE INCIDENCE OF THE ISCHEMIC BRAIN MICROLESIONS AFTER CAROTID ARTERY STENTING

https://doi.org/10.20996/1819-6446-2018-14-1-53-57

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Abstract

Aim. To estimate incidence of periprocedural ischemic brain microlesions after carotid artery stenting (CAS) and to identify most probable predictors. Material and methods. 84 patients with carotid artery stenosis undergoing carotid angioplasty with stenting (CAS) in a specialized medical center, between 2013 and 2016, were examined. All patients had diffusion-weighted magnetic resonance imaging before and after treatment for the detection of new periprocedural ischemic brain microlesions. Statistical analysis was performed using non-parametric methods.

Results. Among the selected patients aged 40 to 83 years (mean age of 60.6±3.9 years) there were 68 men (80.95%) and 16 women (19.05%). 39 (46.4%) of 84 patients had new ischemic brain microlesions after CAS both ipsilateral (37.8%) and non-ipsilateral location. 17.95% of them (n=7) had the transient or persistent neurological symptoms and the rest patients were asymptomatic. Patients with ischemic brain microlesions compared with patients without them were older and had lower hemoglobin level before CAS, history of previous strokes and as well as perioperative arterial hypotension persisting up to 24 hours (p<0.05). Statistically significant differences in atherosclerotic plaques characteristics and CAS technical features were not detected.

Conclusion. Ischemic brain microlesions after CAS, mostly asymptomatic, were detected in about half of patients. Microlesion appearance may be associated with older age, preprocedural lower hemoglobin level, previous strokes and periprocedural hemodynamic instability.

About the Authors

E. A. Bulgakova
National MedicalResearch Center for Preventive Medicine
Russian Federation

Elena S. Bulgakova – MD, Junior Researcher, Department of Fundamental and Applied Aspects of Obesity 

Petroverigsky per. 10, Moscow, 101990



F. B. Shukurov
National MedicalResearch Center for Preventive Medicine
Russian Federation

Firdavs B. Shukurov – MD, Endovascular Surgeon, Department of Roentgen-Endovascular Diagnostics and Treatment (Interventional Cardiology)

Petroverigsky per. 10, Moscow, 101990



B. A. Rudenko
National MedicalResearch Center for Preventive Medicine
Russian Federation

Boris A. Rudenko – MD, PhD, Leading Researcher, Laboratory of Roentgen-Endovascular Diagnostics and Treatment (Interventional Cardiology)

Petroverigsky per. 10, Moscow, 101990



T. V. Tvorogova
Private Clinic "Family"
Russian Federation

Tatiana V. Tvorogova – MD, PhD, Chief Physician 

Textilnaya ul. 16, Moscow Region, Lobnya, 141730

 



O. M. Drapkina
National MedicalResearch Center for Preventive Medicine
Russian Federation

Oxana M. Drapkina – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director 

Petroverigsky per. 10, Moscow, 101990



References

1. Stahovskaya L.V., Kotov S.V. Stroke: a guide for physicians. Moscow: Medicinskoe informacionnoe agentstvo; 2014. (In Russ.) [Стаховская Л.В., Котов С.В. Инсульт: руководство для врачей. М.: Медицинское информационное агентство; 2014].

2. White C.J. Carotid artery stenting. J Am Coll Cardiol. 2014;64(7):722-31. doi: 10.1016/j.jacc.2014.04.069.

3. O'Brien M., Chandra A. Carotid revascularization: risks and benefits. Vasc Health Risk Manag. 2014;10:403-16. doi: 10.2147/VHRM.S48923.

4. Kernan W.N., Ovbiagele B., Black H.R. et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2014;45(7):2160-236. doi: 10.1161/STR.0000000000000024.

5. Gahremanpour A., Perin E.C., Silva G. Carotid artery stenting versus endarterectomy: a systematic review. Tex Heart Inst J. 2012;39(4):474-87.

6. Patel R.A. State of the art in carotid artery stenting: trial data, technical aspects, and limitations. J Cardiovasc Transl Res. 2014;7(4):446-57. doi: 10.1007/s12265-014-9567-3.

7. Tendera M., Aboyans V., Bartelink M.L. et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases. Eur Heart J. 2011;32(22):2851-906. doi: 10.1093/eurheartj/ehr211.

8. Rosenkranz M., Gerloff C. New ischemic brain lesions after carotid artery stenting. J Cardiovasc Surg (Torino). 2013;54(1):93-9.

9. Knur R. Technique and clinical evidence of neuroprotection in carotid artery stenting. Vasa. 2014;43(2):100-12. doi: 10.1024/0301-1526/a000336.

10. Hauth E.A., Jansen C., Drescher R. MR and clinical follow-up of diffusion-weighted cerebral lesions after carotid artery stenting. Am J Neuroradiol. 2005;26:2336-41.

11. Palombo G., Faraglia V., Stella N. et al. Late evaluation of silent cerebral ischemia detected by diffusionweighted MR imaging after filter-protected carotid artery stenting. Am J Neuroradiol. 2008;29:1340-3. doi: 10.3174/ajnr.A1102.

12. Zhou W., Dinishak D., Lane B. et al. Long-term radiographic outcomes of microemboli following carotid interventions. J Vasc Surg. 2009;50:1314-9. doi: 10.1016/j.jvs.2009.07.105.

13. Wolf P.A., D'Agostino R.B., Kannel W.B. et al. Cigarette smoking as a risk factor for stroke. The Framingham Study. JAMA. 1988;259(7):1025-9. doi:10.1001/jama.1988.03720070025028.

14. Kawachi I., Colditz G.A., Stampfer M.J. et al. Smoking cessation and decreased risk of stroke in women. JAMA. 1993;269(2):232-6. doi:10.1001/jama.1993.03500020066033.

15. Bonati L.H., Jongen L.M., Haller S. et al. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol. 2010;9:353-62. doi: 10.1016/S1474-4422(10)70057-0.

16. Bijuklic K., Wandler A., Varnakov Y. et al. Risk factors for cerebral embolization after carotid artery stenting with embolic protection: a diffusion-weighted magnetic resonance imaging study in 837 consecutive patients. Circ Cardiovasc Interv. 2013;6(3):311-6. doi: 10.1161/CIRCINTERVENTIONS.112.000093.

17. Rostamzadeh A., Zumbrunn T., Jongen L.M. et al. Predictors of acute and persisting ischemic brain lesions in patients randomized to carotid stenting or endarterectomy. Stroke. 2014;45(2):591-4. doi: 10.1161/STROKEAHA.113.003605.

18. Staubach S., Hein-Rothweiler R., Hochadel M. et al. Predictors of minor versus major stroke during carotid artery stenting: results from the carotid artery stenting (CAS) registry of the Arbeitsgemeinschaft Leitende Kardiologische KrankenhausКrzte (ALKK). Clin Res Cardiol. 2014;103(5):345-51. doi: 10.1007/s00392-013-0657-z.

19. Ichinose N., Hama S., Tsuji T. et al. Predicting ischemic stroke after carotid artery stenting based on proximal calcification and the jellyfish sign. J Neurosurg. 2017;7:1-9. doi: 10.3171/2017.1.JNS162379.

20. Zhou W., Zareie R., Tedesco M. et al. Risk factors predictive of carotid artery stenting-associated subclinical microemboli. Int J Angiol. 2011;20(1):25-32. doi: 10.1055/s-0031-1272546.

21. Gerhardt U., Vorneweg P., Riedasch M. et al. Acute and persistant effects of smoking on the baroreceptor function. J Auton Pharmacol. 1999;19(2):105-8. DOI: 10.1046/j.1365-2680.1999.00123.x

22. Arosio E., De Marchi S., Rigoni A. et al. Effects of smoking on cardiopulmonary baroreceptor activation and peripheral vascular resistance. Eur J Clin Invest. 2006;36(5):320-5. doi: 10.1111/j.13652362.2006.01628.x.


For citation:


Bulgakova E.A., Shukurov F.B., Rudenko B.A., Tvorogova T.V., Drapkina O.M. THE INCIDENCE OF THE ISCHEMIC BRAIN MICROLESIONS AFTER CAROTID ARTERY STENTING. Rational Pharmacotherapy in Cardiology. 2018;14(1):53-57. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-1-53-57

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)