Prognostic nutrition index may predict cerebral embolic events following carotid artery stenting procedure

Abstract

Objectives: Cerebral embolism after carotid artery stenting (CAS) remains a matter of concern in frailty patients. Prognostic nutrition index (PNI), which provides an objective assessment of nutritional status, is a useful prognostic indicator in cardiovascular diseases. We aim to determine the value of pre-procedural PNI in predicting cerebral embolism including stroke, transient ischemic attack (TIA), and silent new ischemic cerebral lesions (SNICLs). Patients and Methods: We retrospectively evaluated 138 patients (mean age: 70.6±6.7 years, male:99) who underwent CAS. Inclusion criteria were as follows: I) availability of all medical records including albumin value and lymphocyte count, II) having cranial imaging after CAS, III) having symptomatic carotid stenosis 50-99% or asymptomatic carotid stenosis≥60-99%. The study population was divided into two subgroups according to the presence of cerebral embolism as cerebral embolism (+) cerebral embolism (-) groups. Results: Among the study population, 22 patients (16%) had at least 1 SNICL, seven patients (5.0%) had ischemic stroke, and five patients (3.6%) had TIA. The cerebral embolism (+) group had a significantly lower PNI, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the cerebral embolism (-) group. Low PNI was identified as one of the independent predictors of cerebral embolism (OR=0.808; 95%CI: 0.670-0.975; p=0.026), and PNI lower than 44.7 predicted cerebral embolism with a sensitivity of 70.6% and a specificity of 61.1% (AUC: 0.739; 95% CI: 0.651 to 0.827; p<0.001). Conclusion: The current data suggest that PNI is an independent prognostic factor for cerebral embolic complications after CAS procedures.