1 Cardio-Thoraco-Vascular Department, S. Orsola-Malpighi Polyclinic, University of Bologna, Italy.
J Endovasc Ther. 2013 Oct;20(5):684-94. doi: 10.1583/13-4354R.1.
To investigate serological predictors of risk for cerebral embolism after carotid artery stenting (CAS).
Twenty consecutive symptomatic and asymptomatic patients (13 men; mean age 74 years) with carotid artery stenosis undergoing standardized filter-protected CAS (Wallstent) were preoperatively evaluated to identify unstable plaque (duplex ultrasound), complicated aortic plaque (transesophageal echocardiography), and inflammatory status [high-sensitivity C-reactive protein (hs-CRP) and serum amyloid-A protein (SAA) serum levels]. Aortic arch type, carotid tortuosity, and complexity of the procedure were considered. Cerebral embolism was evaluated by comparing the number, volume, and side (ipsilateral and non-ipsilateral) of preoperative and postoperative cerebral lesions detected on diffusion-weighted resonance magnetic imaging (DW-MRI) and through light and scanning electron microscopy analysis of cerebral protection filters obtained from CAS.
All CAS procedures were completed with no complications. All patients had a negative preoperative DW-MRI, but at least 1 asymptomatic cerebral lesion appeared on DW-MRI after the procedure in 18 (90%) patients. Female gender was associated with a higher number of cerebral lesions (18.2±10.9 vs. 8.3±8.8 for men, p=0.03). Carotid plaque morphology, supra-aortic vessel anatomy, and procedure complexity did not correlate with number or volume of new cerebral lesions. Complicated aortic plaque was associated with a higher volume of non-ipsilateral cerebral lesions than uncomplicated plaque (235.0±259.3 vs. 63.6±63.2 mm(3), respectively; p=0.02). Hs-CRP ≥5 mg/L and SAA ≥10 mg/L were significantly associated with a higher number of new cerebral lesions [16.2±10.7 vs. 4.3±3.4 for hs-CRP <5 mg/L (p=0.02) and 14.8±10.3 vs. 2.8±3.4 for SAA <10 mg/L (p=0.006), respectively]. Hs-CRP ≥5 mg/L and SAA ≥10 mg/L also correlated with greater surface involvement by embolic materials in the protection filters at microscopic analysis [37.0% (5.1%) vs. 26.9% (2.5%) for hs-CRP <5 mg/L, p=0.004; 35.9% (13.5%) vs. 22.2% (6.9%) for SAA <10 mg/L, p=0.02].
In addition to female gender and the presence of complicated aortic plaque, inflammatory status can be a predictor of cerebral embolism in CAS.
研究颈动脉支架置入术（CAS）后发生脑栓塞的血清学预测因子。
对 20 例连续的有症状和无症状颈动脉狭窄患者（13 名男性；平均年龄 74 岁）进行了术前评估，以识别不稳定斑块（双功能超声）、复杂主动脉斑块（经食管超声心动图）和炎症状态[高敏 C 反应蛋白（hs-CRP）和血清淀粉样蛋白 A 蛋白（SAA）血清水平]。考虑了主动脉弓类型、颈动脉迂曲和手术的复杂性。通过比较术前和术后扩散加权磁共振成像（DW-MRI）上检测到的脑损伤的数量、体积和侧别（同侧和非同侧），以及通过对 CAS 获得的脑保护过滤器进行光镜和扫描电镜分析，评估脑栓塞。
所有 CAS 手术均顺利完成，无并发症。所有患者术前 DW-MRI 均为阴性，但 18 例（90%）患者术后至少出现 1 例无症状性脑损伤。女性与更多的脑损伤相关（18.2±10.9 与男性 8.3±8.8，p=0.03）。颈动脉斑块形态、主动脉以上血管解剖和手术复杂性与新脑损伤的数量或体积无相关性。复杂主动脉斑块与非同侧脑损伤体积较大相关，而非复杂斑块（235.0±259.3 与 63.6±63.2mm³，分别；p=0.02）。hs-CRP≥5mg/L 和 SAA≥10mg/L 与更多新脑损伤显著相关[hs-CRP<5mg/L 组为 16.2±10.7，hs-CRP≥5mg/L 组为 4.3±3.4（p=0.02）；SAA<10mg/L 组为 14.8±10.3，SAA≥10mg/L 组为 2.8±3.4（p=0.006）]。hs-CRP≥5mg/L 和 SAA≥10mg/L 还与保护过滤器中栓塞材料的更大表面受累相关[hs-CRP<5mg/L 组为 37.0%（5.1%），hs-CRP≥5mg/L 组为 26.9%（2.5%），p=0.004；SAA<10mg/L 组为 35.9%（13.5%），SAA≥10mg/L 组为 22.2%（6.9%），p=0.02]。
除了女性和复杂主动脉斑块外，炎症状态也可能是 CAS 发生脑栓塞的预测因子。
