The predictive value of CHADS2 score for subclinical cerebral ischemia after carotid artery stenting (from the PREVENT‐CAS trial). Issue 2 (21st October 2020)

• Record Type: Journal Article
• Authors: Çelik, Ömer; Güner, Ahmet; Kalçık, Macit; Güler, Arda; Demir, Ali Rıza; Demir, Yusuf; Uygur, Begum; Şahin, Ahmet Anıl; Topel, Çağdaş; Ertürk, Mehmet
• Is Part Of: Catheterization and cardiovascular interventions. Volume 97:Issue 2(2021)
• Page Start: 301
• Page End: 309
• Publication Date: 2020-10-21
• Subjects: carotid -- carotid artery disease -- imaging -- intervention -- interventional MRI -- stroke -- surgery; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29344
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstarct: Background: Carotid artery stenting (CAS) is being increasingly used as an alternative revascularization procedure to carotid endarterectomy; however, subclinical ischemic cerebral lesions after CAS remain as a matter of concern. Hence, we aimed to assess the clinical utility of the CHADS2 score in predicting subclinical ischemic events after CAS. Methods: We prospectively evaluated 107 patients (mean age: 70.4 ± 6.6 years, male:77) who underwent CAS for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after CAS were excluded. The presence of new hyperintense lesion on diffusion‐weighted imaging (DWI) without any neurological findings was considered as silent ischemia. Patients were classified into two groups as DWI‐positive and DWI‐negative patients. Results: Among study population, 28 patients (26.2%) had subclinical embolism. The DWI‐positive group had a significantly higher CHADS2 scores, older age, more frequent history of stroke, higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI‐negative group. Increased CHADS2 score was identified as one of the independent predictors of silent embolism (OR = 5.584; 95%CI: 1.516–20.566; p = .010), and CHADS2 score higher than 2.5 predicted subclinical cerebral ischemia with a sensitivity of 72% and a specificity of 71% (AUC: 0.793; 95% CI: 0.696 – 0.890; p < .001). Conclusions: CHADS2 score was able to predict the risk of periprocedural subclinical ischemic events in CAS and might be of clinical value in the management of patients with carotid artery stenosis.