Abstract
Background. In 30% to 87% patients undergoing carotid artery stenting (CAS), new ischaemic lesions (NILs) of the brain are detected on magnetic resonance imaging (MRI). According to some authors, in 60% cases who undergo CAS via transfemoral (TF) access, NILs are also found in the contralateral and other vascular pools of the brain that are not directly related to the target carotid artery, most likely a result of the endovascular manipulation of the catheter on the aortic arch. An alternative access site for CAS is transradial (TR) access. Theoretically, with TR access, the catheter’s contact with the aortic arch is reduced, particularly with an intervention on the right internal carotid artery, and the risk of embolic events is possibly reduced. However, this aspect has not yet been explored.Aim. The aim of this study was to identify the predictors of NILs of the brain in patients undergoing CAS via the TR and TF approaches.Methods. The study included 96 patients with indications for CAS. Patients were randomised in a 1:1 ratio to either the TR (n = 48) or TF (n = 48) groups. All patients underwent diffusion-weighted imaging MRI before and 12 to 24 hours after the procedure. Multiple logistic regression with step-by-step turning off of variables was used to determine the predictors of NIL.Results. A total of 40 clinical, demographic, instrumental and intraoperative variables were analysed. Based on the results of single regression analysis, 6 predictors (age, male sex, hypertension, history of percutaneous transluminal coronary angioplasty, intersection of the aortic arch and type II/III aortic arch) were included in the multivariate model. From the final multivariate analysis, it was found that age, intersection of the aortic arch and type II/III aortic arch are independent predictors of NILs after CAS.Conclusion. Patient age, type II/III aortic arch and need for a catheter to cross the aortic arch are independent predictors of NILs during carotid stenting. Received 9 January 2020. Revised 21 February 2020. Accepted 25 February 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.
Highlights
Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени академика Е.Н
Транзиторная ишемическая атака определена при неврологическом дефиците с полным регрессом неврологической симптоматики до 24 ч
5. International Carotid Stenting Study Investigators, Ederle J., Dobson J., Featherstone R.L., Bonati L.H., van der Worp H.B., de Borst G.J., Lo T.H., Gaines P., Dorman P.J., Macdonald S., Lyrer P.A., Hendriks J.M., McCollum C., Nederkoorn P.J., Brown M.M. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial
Summary
Поступила в редакцию 9 января 2020 г. Цитировать: Малаев Д.У., Бойков А.А., Прохорихин А.А., Таркова А.Р., Байструков В.И., Фатуллоева Ш.Ш., Кретов Е.И. При каротидной ангиопластике со стентированием трансфеморальным доступом в 60% случаев эти очаги также обнаруживаются в контралатеральной и других сосудистых бассейнах головного мозга, не связанных с целевой сонной артерией. Выявление предикторов новых ишемических очагов головного мозга при каротидной ангиопластике со стентированием трансрадиальным и трансфеморальным доступами. 2/3-й тип дуги аорты и необходимость пересечения катетером оси дуги аорты являются независимыми предикторами новых ишемических очагов при каротидной ангиопластике со стентированием. По данным магнитно-резонансной томографии (МРТ), от 30 до 87% пациентов после КАС обнаруживаются новые ишемические очаги головного мозга [5, 8,9,10]. Целью данного исследования являлось выявление предикторов новых ишемических очагов головного мозга при КАС трансрадиальным и трансфеморальным доступами. До и через 12–24 ч после процедуры всем пациентам проводилась диффузионно-взвешенная магнитно-резонансная томография (ДВ МРТ) головного мозга
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