Hak Jean-François, Arquizan Caroline, Cagnazzo Federico, Mahmoudi Mehdi, Collemiche Francois-Louis, Gascou Gregory, Lefevre Pierre-Henry, Derraz Imad, Labreuche Julien, Mourand Isabelle, Gaillard Nicolas, Corti Lucas, Charif Mahmoud, Costalat Vincent, Dargazanli Cyril
Neuroradiology Department, CHRU Gui de Chauliac, Montpellier University Medical Center, 34295 Montpellier, France.
LIIE, Aix Marseille University, 13005 Marseille, France.
J Pers Med. 2022 Sep 23;12(10):1564. doi: 10.3390/jpm12101564.
In this study, we aimed to determine the frequency and clinical impact of new ischemic lesions detected with diffusion-weighted-imaging-MRI (DWI-MRI) as well as the clinical outcomes after carotid artery stenting (CAS) using the simple flow blockage technique (SFB). This is a retrospective study with data extraction from a monocentric prospective clinical registry (from 2017 to 2019) of consecutive patients admitted for symptomatic cervical ICA stenosis or web. Herein, patients benefited from DWI-MRI before and within 48 h of CAS for symptomatic ICA stenosis or web. The primary endpoint was the frequency of new DWI-MRI ischemic lesions and the secondary (composite) endpoint was the rate of mortality, symptomatic stroke or acute coronary syndrome within 30 days of the procedure. All of the 82 CAS procedures were successfully performed. Among the 33 patients (40.2%) with new DWI-MRI ischemic lesions, 30 patients were asymptomatic (90.9%). Irregular carotid plaque surface with ( = 13, 44.8%) or without ulceration ( = 12, 60.0%) was associated with higher rates of new DWI-MRI lesions by comparison to patients with a regular plaque ( = 7, 25%) ( = 0.048) using the univariate analysis. Less than half of this CAS cohort using the SFB technique had new ischemic lesions detected with DWI-MRI. Among these patients, more than 90% were asymptomatic. Irregularity of the plaque seems to increase the risk of peri-procedural DWI-MRI lesions.
在本研究中，我们旨在确定采用简单血流阻断技术（SFB）进行颈动脉支架置入术（CAS）后，通过扩散加权成像磁共振成像（DWI-MRI）检测到的新发缺血性病变的频率及其临床影响，以及临床结局。这是一项回顾性研究，数据来自一个单中心前瞻性临床注册库（2017年至2019年），该注册库纳入了因症状性颈内动脉（ICA）狭窄或蹼状病变而入院的连续患者。在此，患者在CAS术前及术后48小时内接受了DWI-MRI检查，以评估症状性ICA狭窄或蹼状病变。主要终点是新发DWI-MRI缺血性病变的频率，次要（复合）终点是术后30天内的死亡率、症状性卒中或急性冠状动脉综合征的发生率。所有82例CAS手术均成功完成。在33例（40.2%）出现新发DWI-MRI缺血性病变的患者中，30例无症状（90.9%）。与斑块表面规则的患者相比，斑块表面不规则（n = 13，44.8%）或伴有溃疡（n = 12，60.0%）的患者新发DWI-MRI病变的发生率更高（n = 7，25%）（单因素分析，P = 0.048）。采用SFB技术的这一CAS队列中，不到一半的患者通过DWI-MRI检测到新发缺血性病变。在这些患者中，超过90%无症状。斑块不规则似乎会增加围手术期DWI-MRI病变的风险。
