Dataset Information

Low-Density Lipoprotein Cholesterol Levels Are Associated With Subsequent Stented-Territory Ischemic Stroke After Carotid Artery Stenting: A Single Center Retrospective Study

ABSTRACT:

Objective

The role of low-density lipoprotein cholesterol (LDL-C) after carotid artery stenting (CAS) is not well known with respect to stented-territory infarction (STI) and in-stent restenosis (ISR). We hypothesized that LDL-C levels after CAS might be independently associated with STI and ISR.

Methods

We conducted a retrospective study for patients with significant extracranial carotid stenosis who were subjected to CAS between September 2013 and May 2021. LDL-C levels were measured after 6 and 12 months following CAS. The association between STI and ISR, and LDL-C was explored using Cox proportional-hazard model.

Results

Of 244 patients enrolled, STI and ISR were observed in 11 (4.5%) and 10 (4.1%) patients, respectively. In multivariable analysis, higher white blood cell count (hazard ratio [HR], 1.408 per 103/mm3; 95% confidence interval [CI], 1.085–1.828; p=0.010), higher LDL-C levels after 12 months (HR, 1.037 per 1 mg/dL; 95% CI, 1.011–1.063; p=0.005), and ISR (HR, 13.526; 95% CI, 3.405–53.725; p<0.001) were independent predictors of STI. Diabetes (HR, 4.746; 95% CI, 1.026–21.948; p=0.046), smaller stent diameter (HR, 0.725 per 1 mm; 95% CI, 0.537–0.980; p=0.036), and higher LDL-C levels after 12 months (HR, 1.031 per 1 mg/dL; 95% CI, 1.007–1.055; p=0.011) were independent predictors of ISR.

Conclusion

We showed that LDL-C levels after 12 months independently predict STI and ISR after CAS. It is necessary to investigate the optimal target LDL-C level for STI prevention through well designed research in the future.

SUBMITTER: Kim S

PROVIDER: S-EPMC10232219 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Project description:BackgroundBrain lesions on diffusion-weighted imaging (DWI) are frequently found after carotid artery stenting (CAS), but their clinical relevance remains unclear.ObjectivesThis study sought to investigate whether periprocedural ischemic DWI lesions after CAS or carotid endarterectomy (CEA) are associated with an increased risk of recurrent cerebrovascular events.MethodsIn the magnetic resonance imaging (MRI) substudy of ICSS (International Carotid Stenting Study), 231 patients with symptomatic carotid stenosis were randomized to undergo CAS (n=124) or CEA (n=107). MRIs were performed 1 to 7 days before and 1 to 3 days after treatment. The primary outcome event was stroke or transient ischemic attack in any territory occurring between the post-treatment MRI and the end of follow-up. Time to occurrence of the primary outcome event was compared between patients with (DWI+) and without (DWI-) new DWI lesions on the post-treatment scan in the CAS and CEA groups separately.ResultsMedian time of follow-up was 4.1 years (interquartile range: 3.0 to 5.2). In the CAS group, recurrent stroke or transient ischemic attack occurred more often among DWI+ patients (12 of 62) than among DWI- patients (6 of 62), with a cumulative 5-year incidence of 22.8% (standard error [SE]: 7.1%) and 8.8% (SE: 3.8%), respectively (unadjusted hazard ratio: 2.85; 95% confidence interval: 1.05 to 7.72; p=0.04). In DWI+ and DWI- patients, 8 and 2 events, respectively, occurred within 6 months after treatment. In the CEA group, there was no difference in recurrent cerebrovascular events between DWI+ and DWI- patients.ConclusionsIschemic brain lesions discovered on DWI after CAS seem to be a marker of increased risk for recurrent cerebrovascular events. Patients with periprocedural DWI lesions might benefit from more aggressive and prolonged antiplatelet therapy after CAS. (A Randomised Comparison of the Risks, Benefits and Cost Effectiveness of Primary Carotid Stenting With Carotid Endarterectomy: International Carotid Stenting Study; ISRCTN25337470).

Project description:BackgroundCarotid artery stenting (CAS) is a common treatment for carotid artery stenosis, but it can lead to new ischemic brain lesions on diffusion-weighted images (DWI) during the perioperative period. Identifying these lesions early is crucial to preventing recurrent ischemic strokes.MethodsThis retrospective study included 47 patients who underwent CAS. Preoperative carotid PET/MR examinations and postoperative brain MRI were performed. Clinicians identified the responsible carotid artery based on symptoms and records. Vessel morphology, plaque characteristics, and inflammatory uptake were analyzed. The standardized uptake value and tissue-to-background ratio quantified 18F-fluorodeoxyglucose(18F-FDG) uptake. The symptomatic carotid atheroma inflammation lumen-stenosis(SCAIL) score assessed stenosis severity and inflammation. The primary outcome was the presence of new ischemic lesions on DWI.ResultsAmong the 47 patients (mean age, 65 ± 7 years; 44 males), 30 (63.8%) exhibited new ischemic lesions. These patients had a higher prevalence of AHA type VI plaques (50.0% vs. 17.6%, p = 0.028), higher PET uptake (43.3% vs. 11.8%, p = 0.026), and higher SCAIL scores (63.3% vs. 23.5%, p = 0.009). The most common distribution pattern of new ischemic lesions was located in the mixed (in and beyond of the treated artery) territory (36.2%). Of the 30 participants with new ischemic lesions, 15 (50%) had lesions located in both peripheral brain areas and deep brain areas. In the adjusted model, high PET uptake and SCAIL scores were independently associated with new ischemic lesions (aOR = 7.26, 95% CI: 1.22, 73.59; p = 0.049 and aOR = 7.06 [95% CI: 1.50, 44.18]; p = 0.020).ConclusionCarotid PET/MR-related indicators can effectively predict the risk of new ischemic lesions on DWI during the perioperative period after carotid artery stenting, providing important references for early identification of high-risk patients for recurrent ischemic stroke. Further large-scale randomized controlled studies are necessary to validate the clinical application value of these indicators.

Project description:Background: The occurrence of ischemic lesions is common in patients receiving carotid artery stenting (CAS), and most of them are clinically silent. However, few studies have directly addressed the cognitive sequelae of these procedure-related silent ischemic lesions (SILs). Objective: In this study, we attempted to investigate the effects of SILs on cognition using a comprehensive battery of neuropsychological tests. Method: Eighty-five patients with unilateral carotid stenosis and 25 age-matched healthy volunteers participated in this study. Brain MRI was performed within 1 week before and 1 week after CAS to monitor the occurrence of post-CAS SILs. A comprehensive battery tapping reading ability, verbal and non-verbal memory, visuospatial function, manual dexterity, executive function, and processing speed was administered 1 week before and 6 months after CAS. To control for practice effects on repeated cognitive testing, the reliable change index (RCI) derived from the healthy volunteers was used to determine the cognitive changes in patients with carotid stenosis. Results: Among the 85 patients with carotid stenosis, 21 patients received medical treatment (MED group), and procedure-related SILs were noted in 17 patients (SIL+ group) but not observed in 47 patients (SIL- group) after undergoing CAS. Two-way (group × phase) ANOVA revealed that the volunteer group showed improved scores in most cognitive tests while only limited improvement was noted in the SIL- group. The MED and control groups tended to show improvement in the follow-up cognitive testing than the SIL+ group. However, most of the cognitive changes for each patient group did not exceed the upper or lower limits (z = ±1.0) of the RCI. Conclusions: Although the occurrence of procedure-related SILs is common in patients undergoing CAS, their impacts on cognitive changes after CAS may be limited. The practice effect should be taken into consideration when interpreting cognitive changes following CAS.