Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Neuroimaging. 2023 Jul-Aug;33(4):590-597. doi: 10.1111/jon.13097. Epub 2023 Mar 3.
Stenting is an important treatment for preventing stroke. However, the effect of vertebrobasilar stenting (VBS) might be limited because of relatively high periprocedural risks. Silent brain infarcts (SBIs) are known as a predictor for future stroke. Because of anatomical differences, factors for SBIs might be different between carotid artery stenting (CAS) and VBS. We compared the characteristics of SBIs between VBS and CAS.
We included patients who underwent elective VBS or CAS. Diffusion-weighted imaging was performed pre- and post-procedure to detect new SBIs. Clinical variables, occurrence of SBIs, and procedure-related factors were compared between CAS and VBS. Moreover, we investigated predictors of SBIs in each group separately.
Ninety-two (34.2%) out of 269 patients had SBIs. SBIs were more frequently observed in VBS (29 [56.6%] vs. 63 [28.9%], p<.001). The risk of SBIs outside the stent-inserted vascular territory was higher in VBS compared to CAS (14 [48.3%] vs. 8 [12.7%], p<.001). Larger-diameter stents (odds ratio: 1.28, 95% confidence interval: 1.06-1.54, p = .012) and prolonged procedure time (1.01, [1.00-1.03], p = .026) increased the risk of SBIs in CAS, whereas only age increased the risk of SBIs in VBS (1.08 [1.01-1.16], p = .036).
Compared to CAS, VBS was associated with longer procedure time, more residual stenosis, and more SBIs, especially outside the stent-inserted vascular territory. The risk of SBIs after CAS was associated with stent size and procedural difficulty. Only age was associated with SBIs in VBS. The pathomechanism of SBIs after VBS and CAS may be different.
支架置入术是预防中风的重要治疗手段。然而，由于椎基底动脉支架置入术（VBS）围手术期风险相对较高，其效果可能受到限制。无症状性脑梗死（SBIs）是未来中风的预测因素。由于解剖学差异，颈动脉支架置入术（CAS）和 VBS 之间 SBI 的相关因素可能不同。我们比较了 VBS 和 CAS 之间 SBI 的特征。
我们纳入了接受择期 VBS 或 CAS 的患者。在术前和术后进行弥散加权成像以检测新的 SBI。比较 CAS 和 VBS 之间的临床变量、SBI 的发生和与手术相关的因素。此外，我们分别研究了每组 SBI 的预测因素。
92 例（34.2%）269 例患者中有 SBI。VBS 中 SBI 更为常见（29 例[56.6%] vs. 63 例[28.9%]，p<.001）。与 CAS 相比，VBS 中支架置入血管以外区域 SBI 的风险更高（14 例[48.3%] vs. 8 例[12.7%]，p<.001）。较大直径的支架（比值比：1.28，95%置信区间：1.06-1.54，p =.012）和较长的手术时间（1.01，[1.00-1.03]，p =.026）增加了 CAS 中 SBI 的风险，而只有年龄增加了 VBS 中 SBI 的风险（1.08 [1.01-1.16]，p =.036）。
与 CAS 相比，VBS 与更长的手术时间、更大的残余狭窄和更多的 SBI 相关，尤其是支架置入血管以外区域的 SBI。CAS 后 SBI 的风险与支架大小和手术难度有关。只有年龄与 VBS 中的 SBI 有关。VBS 和 CAS 后 SBI 的发病机制可能不同。
