The effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures (from the COMPLEX-CAS Trial). (April 2022)

• Record Type: Journal Article
• Authors: Güner, Ahmet; Çelik, Ömer; Topel, Çağdaş; Arif Yalçın, Ahmet; Kalçık, Macit; Uzun, Fatih; Altunova, Mehmet; Örten, Murat; Akman, Cemalettin; Güner, Ezgi Gültekin; Ertürk, Mehmet
• Is Part Of: Vascular. Volume 30:Number 2(2022)
• Page Start: 292
• Page End: 300
• Publication Date: 2022-04
• Subjects: Carotid artery -- stenting -- silent new ischemic cerebral lesions -- diffusion-weighted imaging; 616.13
• DOI: 10.1177/17085381211010016
• Languages: English
• ISSNs: 1708-5381

Abstract

Background: Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures. Methods: We prospectively evaluated 122 patients (mean age: 69.5 ± 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients. Results: Among the study population, 32 patients (26.2%) had SNICLs. The DWI-positive group had a significantly higher common carotid artery (CCA)-internal carotid artery (ICA) angle, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI-negative group. High CCA-ICA angle was identified as one of the independent predictors of SNICL (OR (odds ratio) = 1.103 95%CI (confidence interval): (1.023–1.596); p = 0.034), and CCA-ICA angle higher than 34.5 degrees predicted SNICL with a sensitivity of 62.5% and a specificity of 62.2% (area under the curve: 0.680; 95% CI: 0.570 to 0.789; p = 0.003). Conclusions: The higher CCA-ICA angle may predict pre-procedure SNICL risk in carotid artery stenting and may have clinical value in the management of patients with carotid artery stenosis.