Gianluca Faggioli, Rodolfo Pini, Silvia Fittipaldi, Gianandrea Pasquinelli, Caterina Tonon, Elisabetta Beltrandi, Raffaella Mauro, Andrea Stella
Vascular Surgery, University of Bologna, Italy, Bologna, Italy.
OBJECTIVES: Cerebral embolism is a feared complication of carotid artery stenting (CAS) and might be associated with specific morphological patterns, however serological predictors of risk have been scarcely investigated.
METHODS: Consecutive patients with carotid artery stenosis undergoing filter-protected CAS were preoperatively evaluated to identify unstable plaque at duplex ultrasound, complicated aortic plaque at trans-esophageal echocardiography and inflammatory status with high sensitivity C-reactive proteins (hs-CRP) and serum amyloid-A protein (SSA) serum levels. Aortic arch type, carotid tortuosity, and complexity of the procedure were considered. Cerebral embolism was evaluated by comparing number, volume and side of preoperative and postoperative cerebral lesions at diffusion weight resonance magnetic imaging (DW-RMI) and through light and scanning electron microscopy analysis of cerebral protection filters obtained from CAS.
RESULTS: Twenty consecutive patients were submitted to CAS with no complications. At least 1 asymptomatic cerebral lesion on DW-MRI was present in 18 (90%) patients. Female gender was associated with a higher number of cerebral lesions (18.2±10.9 vs. 8.3±8.8 p=0.03). Plaque morphology, supraaortic vessels anatomy and procedure complexity did not correlate with number or volume of new cerebral lesions at DW-RMI. The presence of complicated aortic plaque was associated with higher volume of contralateral cerebral lesions (2350±2593 vs. 636±632 mm3 p=0.02). Hs-CRP>5mg/l and SAA>10 mg/l were significantly associated with a higher number of cerebral lesions (16.2±10.7 vs. 4.3±3.4 p=0.02, and 14.8±10.3 vs. 2.8±3.4 p=0.006, respectively). Hs-CRP>5 and SAA>10 mg/l also correlated with greater surface involvement by embolic materials in the protection filters at microscopic analysis (37.0±5.7 vs. 26.9±2.5 p=0.004).
CONCLUSIONS: Inflammatory status is associated with higher embolic risk during CAS independent from morphological and technical aspects of the procedure.
AUTHOR DISCLOSURES: E. Beltrandi, Nothing to disclose; G. Faggioli, Nothing to disclose; S. Fittipaldi, Nothing to disclose; R. Mauro, Nothing to disclose; G. Pasquinelli, Nothing to disclose; R. Pini, Nothing to disclose; A. Stella, Nothing to disclose; C. Tonon, Nothing to disclose.
Posted April 2012