Risk Factors of Cerebellar Microembolic Infarctions After Carotid Artery Stenting.
Aged
Aged, 80 and over
Angiography, Digital Subtraction
Aorta, Thoracic
Aortic Diseases
/ epidemiology
Brachiocephalic Trunk
Brain Infarction
/ epidemiology
Carotid Stenosis
/ surgery
Cerebellar Diseases
/ epidemiology
Embolic Stroke
/ epidemiology
Endovascular Procedures
/ methods
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Complications
/ epidemiology
Risk Factors
Stents
Vascular Calcification
/ epidemiology
Vertebrobasilar Insufficiency
/ epidemiology
Carotid artery stenting
Cerebellar infarction
Microemboli
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
05
05
2020
revised:
24
06
2020
accepted:
25
06
2020
pubmed:
6
7
2020
medline:
31
3
2021
entrez:
5
7
2020
Statut:
ppublish
Résumé
This study analyzes the incidence of microembolic infarctions (MIs) in the cerebellum after carotid artery stenting (CAS) to determine the risk factors. From 2012 to 2019, 162 CASs in 155 patients were performed at our hospital. Fifty-seven patients (35.7%) showing new MIs on diffusion-weighted imaging after CAS were enrolled. Patients were assigned to either the cerebellar group (n = 14, 8.8%) if their MIs were in the cerebellum and/or cerebrum or the cerebral group (n = 43, 26.9%) if their MIs were only in the cerebrum. Patient characteristics, anatomic features, and clinical data were retrospectively compared between the 2 groups. Advanced age, right-sided carotid stenosis, severe calcification of aortic arch and brachiocephalic trunk, and vertebral artery narrowing with intraprocedural hemodynamic depression (IHD) significantly increased the development of cerebellar MIs. On multivariate analysis, advanced age, right-sided carotid stenosis, and vertebral artery narrowing with IHD were independent predictors of developing new cerebellar MIs. Cerebellar MIs after CAS were not uncommon. Catheter maneuvering in the aortic arch or the brachiocephalic trunk could be the main cause of thromboemboli in cerebellar MIs. Careful attention should be paid to catheter maneuvering, especially in older patients with right-sided carotid lesions. In addition, cerebellar hypoperfusion caused by vertebral artery narrowing with IHD might reduce washout of debris, a cause of cerebellar MIs.
Sections du résumé
BACKGROUND
This study analyzes the incidence of microembolic infarctions (MIs) in the cerebellum after carotid artery stenting (CAS) to determine the risk factors.
METHODS
From 2012 to 2019, 162 CASs in 155 patients were performed at our hospital. Fifty-seven patients (35.7%) showing new MIs on diffusion-weighted imaging after CAS were enrolled. Patients were assigned to either the cerebellar group (n = 14, 8.8%) if their MIs were in the cerebellum and/or cerebrum or the cerebral group (n = 43, 26.9%) if their MIs were only in the cerebrum. Patient characteristics, anatomic features, and clinical data were retrospectively compared between the 2 groups.
RESULTS
Advanced age, right-sided carotid stenosis, severe calcification of aortic arch and brachiocephalic trunk, and vertebral artery narrowing with intraprocedural hemodynamic depression (IHD) significantly increased the development of cerebellar MIs. On multivariate analysis, advanced age, right-sided carotid stenosis, and vertebral artery narrowing with IHD were independent predictors of developing new cerebellar MIs. Cerebellar MIs after CAS were not uncommon.
CONCLUSIONS
Catheter maneuvering in the aortic arch or the brachiocephalic trunk could be the main cause of thromboemboli in cerebellar MIs. Careful attention should be paid to catheter maneuvering, especially in older patients with right-sided carotid lesions. In addition, cerebellar hypoperfusion caused by vertebral artery narrowing with IHD might reduce washout of debris, a cause of cerebellar MIs.
Identifiants
pubmed: 32622063
pii: S1878-8750(20)31475-3
doi: 10.1016/j.wneu.2020.06.207
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e290-e296Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.