Silent Micro-Infarct in Carotid Artery Stenting: Who Has it and Why?

Berna Arli, Gurdal Orhan, Recep Donmez, Umit Gorgulu
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Abstract

Aim: To compare the postprocedural cerebral diffusion-weighted imaging (DWI) findings in cases of carotid stenosis (CS)-related carotid plaques in terms of plaque morphology, degree of stenosis, and the use of a distal protection filter. Moreover, we used DWI to assess the asymptomatic cerebral embolism rates during carotid artery stending (CAS) operations performed for noncalcified versus calcified carotid plaques.

Material and methods: Our study included 99 patients admitted to the Ankara City Hospital Stroke Center in 2022. All of our patients have been evaluated and scheduled for CAS as a result of a decision made by the council. Cases of stenosis of > 50% in symptomatic patients and > 70% in asymptomatic patients were included. The patients were grouped according to their Doppler ultrasonography results. All of the patients underwent DWI within the first 24 hours after the procedure, and then two groups of patients were compared.

Results: A statistically significant difference was found between the distributions of the presence of silent micro-infarcts on DWI in terms of plaque characteristics (p < 0.001). In the patients with normal DWI findings, the percentage of calcified plaques was 38.7%, while the percentages of hypoechoic plaques, plaques with low echogenicity, and ulcerated plaques were 91.3%, 85.7%, and 78.8%, respectively. The rates of calcified plaques and ulcerated plaques differed in the group of patients with silent microinfarcts. The rate of silent micro-infarcts was 61.3% in the patients with calcified plaques, 8.7% in those with hypoechoic plaques, 14.3% in those with low-echogenicity plaques, and 21.2% in those with ulcerated plaques.

Conclusion: The study found that carotid stents implanted in calcified and ulcerated plaques had a higher correlation with the presence of periprocedural asymptomatic ipsilateral DWI findings than those implanted in hypoechoic plaques and low-echogenicity plaques.

颈动脉支架置入术中的无症状微梗塞:谁有,为什么?
目的:颈动脉狭窄(CS)是脑卒中可改变的危险因素之一。我们旨在比较CS相关颈动脉斑块的术后脑弥散加权成像(DWI)结果,包括斑块形态、狭窄程度和远端保护过滤器的使用。我们还使用DWI评估了颈动脉支架术(CAS)期间无症状脑栓塞发生率,这些手术是针对非钙化和钙化颈动脉斑块进行的。材料和方法:我们的研究包括2022年入住安卡拉市医院中风中心的99名患者。根据委员会的决定,我们所有的患者都已接受评估并安排入住CAS。有症状患者中50%的狭窄病例和无症状患者中70%的狭窄病例被包括在内。根据多普勒超声检查结果对患者进行分组。所有患者在手术后的前24小时内接受DWI,然后比较两组患者。结果:在斑块特征方面,DWI上无声微梗死的分布存在统计学显著差异(p 0.001)。在DWI正常的患者中,钙化斑块的百分比为38.7%,而低回声斑块、低回声斑块和溃疡斑块的百分比分别为91.3%、85.7%和78.8%,分别地钙化斑块和溃疡斑块的发生率在无症状微梗死患者组中不同。钙化斑块患者的无症状微梗死发生率为61.3%,低回声斑块患者为8.7%,低回声斑患者为14.3%,溃疡斑块患者为21.2%。结论:研究发现,与植入低回声斑块和低回声斑块的支架相比,植入钙化和溃疡斑块的颈动脉支架与围术期无症状同侧DWI表现的相关性更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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