Impact of residual stenosis on clinical outcomes when performing carotid artery stenting without postdilation

Risk factors for hemodynamic depression after carotid artery stenting: A system review and meta analysis

PURPOSE

Hemodynamic depression (HD) regularly occurs during carotid artery stenting(CAS) for treating carotid stenosis and it could result in adverse clinical events. This review aimed to clarify the incidence and risk factors for HD.

METHODS

We searched four comprehensive databases for studies that reported the incidence or risk factors for HD during CAS. We used a modified version of Newcastle-Ottawa scale to assess the risk of bias in the included studies. We pooled the prevalence rates of HD and related risk factors from individual studies with a generic inverse variance weighted using the randomized effects model. We reported the results using OR with 95 % CI. Funnel plots and Egger's tests were used to assess the publication bias.

RESULTS

Our meta-analysis enrolled 53 articles and revealed that the incidence of HD was 35 %. Patients who had diabetes (OR = 1.28, 95 % CI: 1.07 to 1.54), stenosis-to-bifurcation <10 mm (OR = 2.11, 95 % CI: 1.29 to 3.48), stenosis involving the carotid bulb (OR = 1.9, 95 % CI: 1.07 to 3.38), calcified plaque (OR = 2.06, 95 % CI: 1.32 to 3.22), eccentric plaque (OR = 1.47, 95 % CI: 1.05 to 2.05), severe stenosis (OR = 1.64, 95 % CI: 1.1 to 2.43), contralateral stenosis (OR = 2.02, 95 % CI: 1.18 to 3.46), open-cell stents (OR = 1.5, 95 % CI: 1.04 to 2.15), and bilateral stenting (OR = 2.32, 95 % CI: 1.56 to 3.44) showed a higher risk of HD.

CONCLUSIONS

Diabetes, stenosis-to-bifurcation <10 mm, stenosis involving the carotid bulb, calcified plaque, eccentric plaque, severe stenosis, contralateral stenosis, open-cell stents, and bilateral carotid stenting were associated with HD during CAS.

Increased Serum CRP-Albumin Ratio is Independently Associated With In-Stent Restenosis After Carotid Artery Stenting

Atherosclerotic stenosis of the carotid artery contributes significantly to ischemic strokes. This study investigates the correlation between the C-reactive protein (CRP) to albumin ratio (CAR) and in-stent restenosis (ISR) in patients (n = 529) undergoing carotid artery stenting. Patients were categorized based on ISR occurrence. Cox regression analyses were performed to identify independent predictors of ISR. The ISR rate was 10.3%. Laboratory analysis revealed higher levels of uric acid, CRP, and CAR in the ISR group. Cox regression identified CAR as an independent predictor of ISR (Hazard ratio (HR): 1.13, 95% CI: 1.03-1.24, P = .01), along with diabetes and smoking. A CAR cut-off of 0.28 predicted ISR with 93% sensitivity and 89% specificity (Area under the curve (AUC): 0.945, 95% CI: 0.923-0.963, P < .001). This study establishes a significant association between CAR and ISR in carotid artery stenting patients. The inflammatory response, indicated by CAR, emerges as a crucial factor in ISR development. The study contributes valuable insights into predicting and preventing ISR, emphasizing the potential of CAR as a prognostic biomarker. This easily accessible and cost-effective biomarker could enhance ISR prediction and guide preventive strategies for high-risk patients.

Debris generated by laser and/or balloon cause cerebral infarction with different severity

The purpose of this study is to determine the effects that debris generated by laser and/or balloon on the brain. Debris generated by laser, balloon, and laser combined with balloon were collected and then injected into rats' left common carotid artery. Rats were divided into five groups: sham, saline, laser (L), balloon (B), and laser combined with balloon (LB). The cognition ability of rats was evaluated by Morris water maze. Cerebral blood flow (CBF) was examined by laser speckle. TTC staining and MRI scan were conducted to detect cerebral ischemic infarction. Intracranial arteries in rats were visualized by MRI angiography via contrast medium injected via tail vein. Immunohistologic staining for NeuN and Iba1 and hematoxylin-eosin staining were performed to assess brain infarction. White matter demyelination was assessed by Luxol fast blue staining. Long-term memory and CBF of rats in different groups exhibited no significant difference. No obstruction sign in intracranial artery tree was noticed in each group. Debris generated by different treatments all caused brain infarction. Infarction lesion caused by debris produced by balloon was much more severe than the one caused by debris generated by laser. While the LB group lay in between. The thickness of white matter decreased in the B group, but not in the L and LB groups. Rat brain has a tolerance for debris as cognition ability and cerebral blood flow are not significantly declined. The severity of cerebral infarction varies by debris generated by different treatments.