Journal of Korean Neurosurgical Society

  • 제53권3호
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  • Pages.155-160
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  • 2013
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Risk Factors for Developing Large Emboli Following Carotid Artery Stenting

  • Kwon, Sae Min (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Cheong, Jin Hwan (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Lee, Sang Kook (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Park, Dong Woo (Department of Radiology, Hanyang University Guri Hospital) ;
  • Kim, Jae Min (Department of Neurosurgery, Hanyang University Guri Hospital) ;
  • Kim, Choong Hyun (Department of Neurosurgery, Hanyang University Guri Hospital)
  • 투고 : 2012.08.09
  • 심사 : 2013.02.25
  • 발행 : 2013.03.28
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초록

Objective : The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events. Methods : A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group. Results : Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS. Conclusion : In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.

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참고문헌

  1. Bacharach JM, Slovut DP, Ricotta J, Sullivan TM : Octogenarians are not at increased risk for periprocedural stroke following carotid artery stenting. Ann Vasc Surg 24 : 153-159, 2010 https://doi.org/10.1016/j.avsg.2009.05.010
  2. Baldi S, Zander T, Rabellino M, Gonzalez G, Maynar M : Carotid artery stenting without angioplasty and cerebral protection : a single-center experience with up to 7 years' follow-up. AJNR Am J Neuroradiol 32 : 759-763, 2011 https://doi.org/10.3174/ajnr.A2375
  3. Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L : Silent embolism in diagnostic cerebral angiography and neurointerventional procedures : a prospective study. Lancet 354 : 1594-1597, 1999 https://doi.org/10.1016/S0140-6736(99)07083-X
  4. Cardaioli P, Giordan M, Panfili M, Chioin R : Complication with an embolic protection device during carotid angioplasty. Catheter Cardiovasc Interv 62 : 234-236, 2004 https://doi.org/10.1002/ccd.20061
  5. Castriota F, Cremonesi A, Manetti R, Liso A, Oshola K, Ricci E, et al. : Impact of cerebral protection devices on early outcome of carotid stenting. J Endovasc Ther 9 : 786-792, 2002 https://doi.org/10.1583/1545-1550(2002)009<0786:IOCPDO>2.0.CO;2
  6. Chung J, Shin YS, Lim YC, Park SK : The clinical outcomes of 75 consecutive patients with cervical carotid artery stenosis treated by carotid artery stenting. J Korean NeurosurgSoc 45 : 350-354, 2009 https://doi.org/10.3340/jkns.2009.45.6.350
  7. Diethrich EB, Ndiaye M, Reid DB : Stenting in the carotid artery : initial experience in 110 patients. J Endovasc Surg 3 : 42-62, 1996 https://doi.org/10.1583/1074-6218(1996)003<0042:SITCAI>2.0.CO;2
  8. Dumont TM, Rughani AI : National trends in carotid artery revascularization surgery. J Neurosurg 116 : 1251-1257, 2012 https://doi.org/10.3171/2012.3.JNS111320
  9. Gröschel K, Ernemann U, Schnaudigel S, Wasser K, Nägele T, Kastrup A : A risk score to predict ischemic lesions after protected carotid artery stenting. J Neurol Sci 273 : 112-115, 2008 https://doi.org/10.1016/j.jns.2008.07.004
  10. Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, et al. : Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 358 : 1572-1579, 2008 https://doi.org/10.1056/NEJMoa0708028
  11. Kastrup A, Groschel K, Krapf H, Brehm BR, Dichgans J, Schulz JB : Early outcome of carotid angioplasty and stenting with and without cerebral protection devices : a systematic review of the literature. Stroke 34 : 813-819, 2003 https://doi.org/10.1161/01.STR.0000058160.53040.5F
  12. Kastrup A, Groschel K, Schnaudigel S, Nagele T, Schmidt F, Ernemann U : Target lesion ulceration and arch calcification are associated with increased incidence of carotid stenting-associated ischemic lesions in octogenarians. J Vasc Surg 47 : 88-95, 2008 https://doi.org/10.1016/j.jvs.2007.09.045
  13. Lian X, Liu W, Li M, Lin M, Zhu S, Sun W, et al. : Risk factors and complications associated with difficult retrieval of embolic protection devices in carotid artery stenting. Cardiovasc Intervent Radiol 35 : 43-48, 2012 https://doi.org/10.1007/s00270-011-0117-y
  14. McDonnell CO, Fearn SJ, Baker SR, Goodman MA, Price D, Lawrence-Brown MM : Value of diffusion-weighted MRI during carotid angioplasty and stenting. Eur J Vasc Endovasc Surg 32 : 46-50, 2006 https://doi.org/10.1016/j.ejvs.2005.12.026
  15. Sayeed S, Stanziale SF, Wholey MH, Makaroun MS : Angiographic lesion characteristics can predict adverse outcomes after carotid artery stenting. J Vasc Surg 47 : 81-87, 2008 https://doi.org/10.1016/j.jvs.2007.09.047
  16. Serrador JM, Picot PA, Rutt BK, Shoemaker JK, Bondar RL : MRI measures of middle cerebral artery diameter in conscious humans during simulated orthostasis. Stroke 31 : 1672-1678, 2000 https://doi.org/10.1161/01.STR.31.7.1672
  17. Tedesco MM, Coogan SM, Dalman RL, Haukoos JS, Lane B, Loh C, et al. : Risk factors for developing postprocedural microemboli following carotid interventions. J Endovasc Ther 14 : 561-567, 2007 https://doi.org/10.1583/1545-1550(2007)14[561:RFFDPM]2.0.CO;2
  18. Tedesco MM, Lee JT, Dalman RL, Lane B, Loh C, Haukoos JS, et al. : Postprocedural microembolic events following carotid surgery and carotid angioplasty and stenting. J Vasc Surg 46 : 244-250, 2007 https://doi.org/10.1016/j.jvs.2007.04.049
  19. Veith FJ, Amor M, Ohki T, Beebe HG, Bell PR, Bolia A, et al. : Current status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders. J Vasc Surg 33(2 Suppl) : S111-S116, 2001 https://doi.org/10.1067/mva.2001.111665
  20. Wu YM, Wong HF, Chen YL, Wong MC, Toh CH : Carotid stenting of asymptomatic and symptomatic carotid artery stenoses with and without the use of a distal embolic protection device. Acta Cardiol 66 : 453-458, 2011 https://doi.org/10.1080/AC.66.4.2126593
  21. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. : Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351 : 1493-1501, 2004 https://doi.org/10.1056/NEJMoa040127
  22. Zarins CK : Carotid endarterectomy : the gold standard. J Endovasc Surg 3 : 10-15, 1996 https://doi.org/10.1583/1074-6218(1996)003<0010:CETGS>2.0.CO;2

피인용 문헌

  1. WIRION™ embolic protection system for carotid artery stenting and lower extremity endovascular intervention vol.16, pp.5, 2013, https://doi.org/10.2217/fca-2020-0023
  2. Intravascular Lithotripsy for Treatment of Calcified Lesions During Carotid Artery Stenting vol.28, pp.1, 2013, https://doi.org/10.1177/1526602820954244