Medical Care Center Prof. Mathey, Prof. Schofer, Hamburg University Cardiovascular Center, Hamburg, Germany.
JACC Cardiovasc Interv. 2013 Apr;6(4):394-8. doi: 10.1016/j.jcin.2012.10.019. Epub 2013 Mar 20.
This study sought to analyze the impact of new asymptomatic cerebral ischemic lesions, found in diffusion-weighted magnetic resonance imaging (DW-MRI) after carotid artery stenting (CAS) in relation to other risk factors for major adverse cerebral and cardiovascular events (MACCE) defined as death, stroke, and myocardial infarction.
After CAS, new cerebral lesions have been reported in up to 70% of patients. The impact of asymptomatic lesions on prognosis after CAS has not been studied.
Eight hundred thirty-seven consecutive patients underwent CAS with cerebral embolic protection. In 728 patients (86.9%), a pre- and post-procedural DW-MRI was available; these patients were included in the analyses. Multivariate Cox regression analysis and Kaplan-Meier estimates were performed to identify independent risk factors for MACCE at follow-up. Clinical, procedural, and lesion characteristics and DW-MRI findings were included in the analyses.
Post-procedure new cerebral ischemic lesions were detected in 32.8% (n = 241) of patients. Fifteen patients (1.79%) had a periprocedural MACCE and were therefore excluded from the analysis. At a mean follow-up of 766.8 ± 513.4 days (range 30 to 2,577 days), MACCE occurred in 45 patients (6.2%). Cox regression analysis and Kaplan-Meier estimates both identified diabetes as the only significant independent risk factor of MACCE. Asymptomatic cerebral lesions after CAS were not associated with MACCE.
Beyond 30 days, diabetes is the only risk factor of MACCE at follow-up. Asymptomatic cerebral embolic events after CAS had no prognostic impact.
本研究旨在分析颈动脉支架置入术（CAS）后扩散加权磁共振成像（DW-MRI）中新发现的无症状性脑缺血性病变对主要不良脑心血管事件（MACCE）的影响，MACCE 定义为死亡、卒中和心肌梗死。
CAS 后，高达 70%的患者报告出现新的脑部病变。无症状性病变对 CAS 后预后的影响尚未得到研究。
837 例连续患者接受了脑保护装置下的 CAS。在 728 例（86.9%）患者中，术前行和术后均可行 DW-MRI；这些患者被纳入分析。采用多变量 Cox 回归分析和 Kaplan-Meier 估计来确定随访期间 MACCE 的独立危险因素。分析中包括临床、手术和病变特征以及 DW-MRI 结果。
32.8%（n=241）的患者术后出现新的脑缺血性病变。15 例患者（1.79%）发生围手术期 MACCE，因此被排除在分析之外。平均随访 766.8±513.4 天（范围 30 至 2577 天）后，45 例患者发生 MACCE（6.2%）。Cox 回归分析和 Kaplan-Meier 估计均表明糖尿病是 MACCE 的唯一显著独立危险因素。CAS 后无症状性脑病变与 MACCE 无关。
超过 30 天后，糖尿病是随访中唯一的 MACCE 危险因素。CAS 后无症状性脑栓塞事件对预后无影响。
