Distal normal vessel diameter might be associated with silent brain infarcts after stenting for symptomatic carotid stenosis

Jae-Chan Ryu; Sang-Hun Lee; Boseong Kwon; Yunsun Song; Deok Hee Lee; Bum Joon Kim; Dong-Wha Kang; Sun U Kwon; Jong S Kim; Jun Young Chang

doi:10.1016/j.jocn.2024.05.001

Distal normal vessel diameter might be associated with silent brain infarcts after stenting for symptomatic carotid stenosis

J Clin Neurosci. 2024 May 9:125:1-6. doi: 10.1016/j.jocn.2024.05.001. Online ahead of print.

Authors

Affiliations

¹ Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.
² Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
³ Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea.
⁵ Departments of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: noyerpapa@gmail.com.

PMID: 38728814
DOI: 10.1016/j.jocn.2024.05.001

Abstract

Background: Carotid artery stenting (CAS) has been the standard treatment for carotid stenosis because it is less invasive; however, the risk of periprocedural thromboembolism is high. We investigated the predictors for silent brain infarcts (SBIs), focusing on embolic protection in CAS.

Methods: This study was single-center retrospective study, and we obtained baseline demographics and clinical, laboratory, and periprocedural variables of patients who underwent CAS. Also, methods used for embolic protection (no EPD, distal EPD, or proximal balloon guiding catheter) during CAS were obtained. Distal normal vessel diameter was defined as the diameter of cervical internal carotid artery where the artery wall becomes parallel. Diffusion-weighted imaging was performed before and after procedure to detect SBIs. The primary outcome was stented territory SBIs, and the secondary outcomes were any territories SBIs and stented territory SBIs in cases with EPD.

Results: A total of 196 CAS procedures with mean age 69.1 ± 9.9 years were included. After CAS, stented territory SBIs occurred in 53 (27.0 %) cases and any territories SBIs in 60 (30.6 %) cases. Univariable analyses revealed that distal normal vessel diameter (odds ratio = 1.71, 95 % confidence interval = 1.20-2.43, P = 0.003) was associated with the occurrence of stented territory SBIs after CAS. After adjusting for potential variables, larger distal normal vessel diameter (1.61 [1.10-2.36], P = 0.014) increased the occurrence of SBIs after CAS. Consistent results were obtained when the outcome was any territories SBIs or stented territory SBIs in cases with EPD.

Conclusions: Distal normal vessel diameter was a predictor for the occurrence of SBI after CAS. The passable pore size of EPDs may vary depending on vessel diameter, and may impact the occurrence of SBIs.

Keywords: Carotid artery stenting; Embolic protection device; Silent brain infarct; Vessel diameter.