Akkaya Emre, Vuruskan Ertan, Gul Zeynep Bastug, Yildirim Aydın, Pusuroglu Hamdi, Surgit Ozgur, Kalkan Ali Kemal, Akgul Ozgur, Akgul Gamze Pinar, Gul Mehmet
Department of Cardiology, Mehmet Akif Ersoy Thorasic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, Gaziantep State Hospital, Gaziantep, Turkey.
Int J Cardiol. 2014 Sep 20;176(2):478-83. doi: 10.1016/j.ijcard.2014.07.241. Epub 2014 Aug 12.
Proximal cerebral protection devices have been developed as an alternative to filter protection devices for reducing neurological complications during carotid artery stenting (CAS). The aim of the present study was to evaluate the frequency of silent cerebral embolism after CAS using different cerebral embolic protection devices and the impact of silent cerebral embolism on neurocognitive function.
One hundred consecutive patients who underwent CAS were enrolled. The patients were randomized to either proximal balloon occlusion or filter protection. Neurocognitive tests were performed before and six months after CAS. Cerebral embolisms were evaluated with diffusion-weighted magnetic resonance imaging (DW-MRI).
The number and volume of new ischemic lesions found with DW-MRI were higher in the filter protection group than in the proximal balloon occlusion group. According to our definition, nine (21%) patients in the balloon occlusion group and 16 (36%) patients in the filter protection group showed neurocognitive decline, and ten (23%) patients in the balloon occlusion group and four (9%) patients in the filter protection group showed neurocognitive improvement (NS). Regarding the group of patients with new cerebral ischemic lesions on DW-MRI, neurocognitive decline occurred in 14 (31%) of 45 patients with DW-MRI lesions and 11 (26%) of 43 patients without DW-MRI lesions (NS).
Neurocognitive outcome after CAS is unpredictable; both neurocognitive decline and improvement can occur. In this study, the proximal balloon occlusion system significantly decreased cerebral microemboli during CAS compared to filter protection. Cerebral microembolism was not found to be associated with neurocognitive decline.
近端脑保护装置已被开发出来，作为滤器保护装置的替代方案，以减少颈动脉支架置入术（CAS）期间的神经并发症。本研究的目的是评估使用不同脑栓塞保护装置进行CAS后无症状脑栓塞的发生率，以及无症状脑栓塞对神经认知功能的影响。
连续纳入100例行CAS的患者。将患者随机分为近端球囊闭塞组或滤器保护组。在CAS前和术后6个月进行神经认知测试。采用扩散加权磁共振成像（DW-MRI）评估脑栓塞情况。
DW-MRI发现的新缺血性病变数量和体积在滤器保护组高于近端球囊闭塞组。根据我们的定义，球囊闭塞组有9例（21%）患者和滤器保护组有16例（36%）患者出现神经认知功能下降，球囊闭塞组有10例（23%）患者和滤器保护组有4例（9%）患者出现神经认知功能改善（无统计学差异）。在DW-MRI上有新脑缺血性病变的患者组中，45例有DW-MRI病变的患者中有14例（31%）出现神经认知功能下降，43例无DW-MRI病变的患者中有11例（26%）出现神经认知功能下降（无统计学差异）。
CAS后的神经认知结果不可预测；神经认知功能下降和改善都可能发生。在本研究中，与滤器保护相比，近端球囊闭塞系统在CAS期间显著减少了脑微栓子。未发现脑微栓塞与神经认知功能下降有关。
