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Home > Vascular Annual Meeting > faggioli_ipsilateral_contralateral

Ipsilateral and Contralateral Cerebral Embolization Is Correlated with Aortic Arch Characteristics in Carotid Stenting

Gianluca Faggioli, Monica Ferri, Raffaele Lodi, Caterina Tonon, Claudio Rapezzi, Elena Biagini, Bruno Barbiroli, Cristina Rossi, Andrea Stella.
University of Bologna, Bologna, Italy.

OBJECTIVES: Carotid artery stenting (CAS) leads to frequent embolic brain lesions; their source has not been clearly identified yet. In order to investigate this phenomenon, we have evaluated embolic brain lesions (BL) after CAS and correlated them with aortic arch (AA) characteristics.

METHODS: The AAs of 44 patients undergoing CAS under distal protection were evaluated by angiography and TransEsophageal Echocardiography (TEE). AAs were stratified according to morphology (type I and II vs. type III and bovine), tortuosity index (sum of all angles diverging from ideal carotid axis, <vs.>150); and atherosclerotic lesions (complex: >5 mm or with mobile debris vs. non complex: <5 mm). Technical details (guidewires, catheters, filters and stents used, procedure time) were also considered. Diffusion Weighted Imaging (DWI) was performed before and within 24 hours from CAS. New BL were considered consistent (CL) if ipsilateral to the site of CAS and inconsistent (IL) if contralateral to it or bilateral. Statistical analysis was by Wilcoxon and Fisher’s exact test, with significance at p<0.05.

RESULTS: Type III and bovine AA morphology were present in 13 patients (29.5%), TI>150 in 24 (54.5%) and complex lesions in 16 (36.3%). New lBL appeared in 25 - 56.8% patients (6-13.6% CL and 38-86.4% IL). The mean number of BL was 5.7 (0-20), 4.7 CL and 5.7 IL, with a median volume of 1119.65±510.7 mm³. TI, type of arch, and atherosclerotic lesions were not correlated with mean number of BL (3.7 vs. 4.25 and 4 respectively p=ns). Mean volume of BL was greater in patients with type III or bovine AA and in patients with complex plaques (1274.59±353.35 mm³ vs. 373.45±91.89 mm³, p=0.18; and 1192.38±348.25 mm³ vs. 278.08±71.53 mm³ p=0.15 respectively). In patients with all three AA characteristics, mean volume of BL was significantly greater (3340.86±414.32 vs. 344.12±64.76 mm³ p=0.002). Specifically this increase was due mainly to IL (CL 997.11±216.89 mm³ vs. 245.77±83.58 mm³, p=0.06; IL 2343.75±104.02 mm³ vs. 98.29± 59.67 mm³ p=0.0006). None of the technical details considered was correlated with either CL or IL.

CONCLUSIONS: Both CL and IL are frequent after protected CAS. IL are correlated with AA characteristics, thus underlining the role of catheterization maneuvers in determining embolic events. TEE may be useful in patient’s selection for CAS.

AUTHOR DISCLOSURES: G. Faggioli, None; M. Ferri, None; R. Lodi, None; C. Tonon, None; C. Rapezzi, None; E. Biagini, None; B. Barbiroli, None; C. Rossi, None; A. Stella, None.