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Osipova OS, Bugurov SV, Gostev AA, Saaya SB, Cheban AV, Ignatenko PV, Karpenko AA. Impact of shaggy aorta on intraoperative cerebral embolism during carotid artery stenting. INT ANGIOL 2024; 43:298-305. [PMID: 38801345 DOI: 10.23736/s0392-9590.24.05150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Careful selection of patients for carotid stenting is necessary. We suggest that patients with a shaggy aorta syndrome may be at higher risk for perioperative embolic complications. METHODS The study is a retrospective subanalysis of the SIBERIA Trial. We included 72 patients undergoing transfemoral carotid artery stenting. Patients were monitored during the procedures using multifrequency transcranial Doppler with embolus detection and differentiation. Pre- and postprocedural (2 and 30 days) cerebral diffusion-weighted cerebral MRIs were performed. RESULTS Forty-six patients had shaggy aorta syndrome. Intraoperative embolisms were recorded in 82.6% and 46.1% of patients with and without shaggy aorta syndrome, respectively (P=0.001). New asymptomatic ischemic brain lesions in the postoperative period occurred in 78.3% and in 26.9% of patients with and without shaggy aorta syndrome, respectively (P<0.001). There were no cases of stroke within 2 days in both groups. 3 (6.5%) cases of stroke within 30 days after the procedure were observed only in patients with shaggy aorta syndrome. There were no cases of contralateral stroke. Shaggy aorta syndrome (OR 5.54 [1.83:16.7], P=0.001) and aortic arch ulceration (OR 6.67 [1.19: 37.3], P=0.02) were independently associated with cerebral embolism. Shaggy aorta syndrome (OR 9.77 [3.14-30.37], P<0.001) and aortic arch ulceration (OR 12.9 [2.3: 72.8], P=0.003) were independently associated with ipsilateral new asymptomatic ischemic brain lesions. CONCLUSIONS Shaggy aorta syndrome and aortic arch ulceration significantly increase the odds of intraoperative embolism and new asymptomatic ischemic brain lesions. Carotid endarterectomy or transcervical carotid stent should be selected in patients with shaggy aorta syndrome.
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Affiliation(s)
- Olesia S Osipova
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia -
| | - Savr V Bugurov
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Alexander A Gostev
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Shoraan B Saaya
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Alexey V Cheban
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Pavel V Ignatenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Andrey A Karpenko
- Center for Vascular and Hybrid Surgery, Meshalkin National Medical Research Center, Novosibirsk, Russia
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Lamarca MP, Flores Á, Martín A, Peinado J, Estébanez S, Arriola M, Llergo B, García E, Tique J, Torralbas F, Millán E, Rigolin M, Lobato P, Segundo JC, Morín M, Jamilena Á, Moreno R, Orgaz A. Prospective evaluation of acute cerebral injury by DW-MRI following transcarotid artery revascularization using a double-layer micromesh stent. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:583-590. [PMID: 38078708 DOI: 10.23736/s0021-9509.23.12764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Transcervical carotid artery revascularization (TCAR) has demonstrated a low overall stroke rate in carotid artery stenting (CAS). Furthermore, the use of a double-layer micromesh stent is expected to reduce embolization and plaque prolapse. The combination of TCAR and the double layer stent may lead to improved results compared to previously reported outcomes. The objective of this study is to present the findings of a prospective study including patients treated with the Roadsaver stent and TCAR. METHODS Between January 2017 and May 2022, 85 patients were enrolled. Every patient underwent TCAR with the Roadsaver stent. As per our protocol, a neurological examination and an ultrasound were performed within 24 hours before and after the procedure, and again 30 days after. A diffusion-weighted magnetic resonance imaging (DW-MRI) was conducted 24 hours before the procedure and 48-72 hours after the procedure. The primary endpoint was the detection of new ischemic lesions on postoperative DW-MRI. The secondary endpoint was a composite of all strokes, death, and myocardial infarction within 30 days. RESULTS Sixty-four patients (75.29%) were symptomatic, out of which 25 were treated within 14 days of the onset of the symptoms. Pre and postprocedural DW-MRI were performed in 83 patients. Postprocedural lesions were found in nine patients (10.84%). There were no strokes or death within 30 days, but two patients experienced a myocardial infarction. CONCLUSIONS Our study suggests that the use of TCAR and the Roadsaver stent could be a safe alternative to carotid endarterectomy because it entails a low incidence of cerebral embolization, even in recently symptomatic and elderly patients.
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Affiliation(s)
- María P Lamarca
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain -
| | - Ángel Flores
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Alberto Martín
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Javier Peinado
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Santiago Estébanez
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Maite Arriola
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Belén Llergo
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Enrique García
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Julián Tique
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Fredy Torralbas
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Elisa Millán
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Martina Rigolin
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Paula Lobato
- Stroke Section, Department of Neurology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - José C Segundo
- Stroke Section, Department of Neurology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Mar Morín
- Stroke Section, Department of Neurology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Álvaro Jamilena
- Stroke Section, Department of Neurology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Raquel Moreno
- Neuroradiology Section, Department of Radiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Antonio Orgaz
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario de Toledo, Toledo, Spain
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Relationship between annular calcification of plaques in the carotid sinus and perioperative hemodynamic disorder in carotid angioplasty and stenting. J Stroke Cerebrovasc Dis 2022; 31:106634. [PMID: 35963212 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the correlation between annular plaque calcification in the carotid sinus and perioperative hemodynamic disorder (HD) in carotid angioplasty and stenting (CAS). METHODS The clinical data of 49 patients undergoing CAS due to narrowing of the carotid sinus were retrospectively analyzed. All patients had preoperative carotid computed tomography angiography (CTA) and were divided into HD and non-HD groups based on the occurrence of HD in the perioperative period of CAS. HD was defined as persistent bradycardia (heart rate < 60 beats per min) or persistent hypotension (systolic blood pressure < 90 mmHg) in the perioperative period and lasting for at least 1 h. The baseline data, including the degree of carotid artery stenosis, plaque length, plaque thickness, calcified plaque morphologies (i.e., plaque circumferential angle: < 90° defined as dotted calcification; 90°-180° defined as arcuate calcification; > 180° defined as annular calcification), contralateral carotid artery conditions, balloon diameter, and stent types, were compared between the two groups. Binary logistic regression was used to analyze the risk factors for the occurrence of HD. RESULTS Among the 49 patients undergoing CAS, 14 (28.57%) developed perioperative HD, and 35 did not. Annular calcification was more common in the patients in the HD group than in the non-HD group. No significant differences in the probabilities of dotted and arcuate calcifications were found between the two groups (p > 0.05). The duration of continuous dopamine consumption in the HD group was 9-71 h. The average hospital stay of the HD group (10.14 ± 4.17 days) was significantly longer than that of the non-HD group (6.57 ± 1.9 days; p < 0.001). Patients in the HD group had significantly more pronounced lumen stenosis (p = 0.033) and longer plaque length (p = 0.034) than those in the non-HD group. After adjusting for age and sex, multivariate regression analysis showed that the presence of annular plaque calcification was an independent predictor of HD (odds ratio: 7.68, 95% confidence interval: 1.46-40.37, p = 0.016). CONCLUSIONS The occurrence of annular plaque calcification in the carotid sinus was an independent risk factor for perioperative HD in CAS. Preoperative carotid CTA assists with the early identification of high-risk patients who may develop HD.
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