Risk Factors of Contralateral Microembolic Infarctions Related to Carotid Artery Stenting
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- ITO Hidemichi
- Department of Neurosurgery, St. Marianna University School of Medicine
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- UCHIDA Masashi
- Department of Neurosurgery, St. Marianna University School of Medicine
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- SASE Taigen
- Department of Neurosurgery, St. Marianna University School of Medicine
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- KUSHIRO Yuichiro
- Department of Neurosurgery, St. Marianna University School of Medicine
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- WAKUI Daisuke
- Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
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- ONODERA Hidetaka
- Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital
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- TAKASUNA Hiroshi
- Department of Neurosurgery, St. Marianna University School of Medicine
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- MORISHIMA Hiroyuki
- Department of Neurosurgery, Kawasaki City Municipal Hospital
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- OSHIO Kotaro
- Department of Neurosurgery, St. Marianna University School of Medicine
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- TANAKA Yuichiro
- Department of Neurosurgery, St. Marianna University School of Medicine
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説明
<p>This study sought to analyze the incidence of contralateral microembolic infarctions (MIs) on diffusion-weighted imaging (DWI) following protected carotid artery stenting (CAS) and compared the difference of risk factors between ipsilateral and contralateral lesions. From April 2010 to March 2017, 147 CASs in 140 patients were performed. All the patients underwent DWI within 1 week before and 24 hrs after the procedures. CAS was successfully completed in 145 (98.6%) of the 147 procedures. Forty-nine (33.8%) patients with new MIs revealed on postprocedural DWI were enrolled. They were divided into ipsilateral and contralateral groups based on the side of the CAS and MIs. The ipsilateral group indicates patients with MIs exclusively on the side of CAS. The contralateral group includes patients with MIs on the opposite side of the CAS or both sides. Patients with MIs at vertebrobasilar territory were excluded. Patient characteristics, morphology of the carotid artery and aortic arch, and procedural data were retrospectively assessed and compared between the two groups. Twenty-two (15.2%) and 14 (9.7%) patients were assigned to the ipsilateral and contralateral groups, respectively. Advanced age, left-sided stenosis, severe aortic arch calcification (AAC) on chest X-ray and contralateral carotid occlusion significantly increased the occurrence of contralateral MIs. On multivariable logistic regression analysis, severe AAC was statistically more frequent in the contralateral group. In the present study, the incidences of contralateral MIs after CAS is relatively not low. Advanced aortic atherosclerosis is statistically predictive for contralateral MIs. AAC on chest X-ray is a useful finding for estimating aortic atherosclerosis in candidates for CAS.</p>
収録刊行物
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- Neurologia medico-chirurgica
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Neurologia medico-chirurgica 58 (7), 311-319, 2018
一般社団法人 日本脳神経外科学会
