Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population.

BACKGROUND: Metabolic syndrome (MetS) is relatively common worldwide and an important risk factor for cardiovascular diseases. It is closely linked to arterial stiffness of the carotid artery. However, the association of MetS with the safety of carotid revascularization has been rarely studied. The aim of this study was to observe the current status of MetS and its components in Chinese carotid revascularized patients, and investigate the impact on major adverse clinical events (MACEs) after carotid endarterectomy (CEA) or carotid artery stenting (CAS). METHODS: From January 2013 to December 2017, patients undergoing CEA or CAS in the Neurosurgery Department of Xuanwu Hospital were retrospectively recruited. The changes in prevalence of MetS and each component with time were investigated. The primary outcome was 30-day post-operative MACEs. Univariable and multivariable analyses were performed to identify the impact of MetS on CEA or CAS. RESULTS: A total of 2068 patients who underwent CEA (766 cases) or CAS (1302 cases) were included. The rate of MetS was 17.9%; the prevalence rate of MetS increased with time. The occurrence rate of MACEs in CEA was 3.4% (26 cases) and in CAS, 3.1% (40 cases). There was no statistical difference between the two groups (3.4% vs. 3.1%, P = 0.600). For CEA patients, univariate analysis showed that the MACE (+) group had increased diabetes history (53.8% vs. 30.9%, P = 0.014) and MetS (34.6% vs. 15.8%, P = 0.023). For CAS patients, univariate analysis showed that the MACE (+) group had increased coronary artery disease history (40.0% vs. 21.6%, P = 0.006) and internal carotid artery tortuosity (67.5%% vs. 37.6%, P < 0.001). Furthermore, the MACE (+) group had higher systolic blood pressure (143.38 ±â€Š22.74 vs. 135.42 ±â€Š17.17 mmHg, P = 0.004). Multivariable analysis showed that the influencing factors for MACEs in CEA included history of diabetes (odds ratio [OR] = 2.345; 95% confidence interval [CI] = 1.057-5.205; P = 0.036) and MetS (OR = 2.476; 95% CI = 1.065-5.757; P = 0.035). The influencing factors for MACEs in CAS included systolic blood pressure (OR = 1.023; 95% CI = 1.005-1.040; P = 0.010), coronary artery disease (OR = 2.382; 95% CI = 1.237-4.587; P = 0.009) and internal carotid artery tortuosity (OR = 3.221; 95% CI = 1.637-6.337; P = 0.001). CONCLUSIONS: The prevalence rate of MetS increased with time in carotid revascularized patients. MetS is a risk for short-term MACEs after CEA, but not CAS.

[Stenting of subtotal conclusion of internal carotid artery and comparing the cerebral embolic load of proximal balloon protection device with distal filter protection device].

OBJECTIVE: To study the safety, efficacy and perioperative complications of endovascular therapy in the treatment of subtotal conclusion of internal carotid artery(ICA) in patients. To compare the cerebral embolic load of proximal balloon protection device versus distal filter protection device during the operation. METHODS: Review all the operations of stenting for subtotal conclusion of ICA in Xuanwu hospital. New cerebral infarction after stenting was assessed by diffusion-weighted magnetic resonance imaging. Count the number of new ischemic lesions of every patient. RESULTS: 35 patients with subtotal conclusion of ICA received endovascular stenting. Proximal protective device was used for 21 patients. Distal protective device was used for 14 patients. All procedures succeeded. 32 patients received the cerebral MRI 1 week before and within 48 hours after the operation. Compared with filter protection(n = 14), proximal balloon device(n = 18) resulted in a significant reduction in the incidence of new cerebral infarction (6/18 vs 10/14, P = 0.03). The number of new cerebral ischemic lesions were significant reduced by proximal balloon device (1/18 vs 4/14, P = 0.0006) . There were no serious cardiovascular events in 35 patients during the operation and the following up 3 months. 3 patients had restenosis which was demonstrated by ultrasound of ICA at 3 months after stenting. CONCLUSIONS: Endovascular stenting may be a safe and valid method for the treatment of subtotal occlusion of ICA. For the stenting of subtotal occlusion of ICA, proximal balloon protection device as compared with filter protection may reduce the embolic load to the brain more effectively. The stenting of subtotal occlusion of ICA still needs the randomized trails to confirm the safety and validity.

Thirty-day outcome of carotid artery stenting in Chinese patients: a single-center experience.

BACKGROUND: Carotid artery stenting (CAS) as a competing treatment modality has had to adhere to limits to gain widespread acceptance in some studies. This study analyzed the clinical data of 1700 consecutive patients after CAS to retrospectively evaluate the 30-day outcome of CAS for internal carotid artery stenosis in a Chinese population. METHODS: Medical records of 1700 patients who underwent CAS at Xuanwu Hospital affiliated to Capital Medical University between January 2001 and August 2012 were reviewed. Postoperative 30-day complication rates were analyzed and compared with those of other studies. Univariate and multivariate Logistic regression analyses were used to identify factors associated with perioperation myocardial infarction (MI), stroke, and death. RESULTS: The overall 30-day rate of MI, stroke, and death after CAS was 2.53%. In univariate analysis, patients who were symptomatic, had a neurological deficit (modified Rankin score (mRS) ≥3; P = 0.001), and who were not taking statins experienced a significantly increased rate of MI, stroke, and death (P = 0.017). In multivariate Logistic regression analysis, the presence of symptoms (odds ratio (OR) = 2.485; 95% confidence interval (CI) = 1.267-4.876; P = 0.008) and a neurological deficit (mRS ≥3) (OR = 3.025; 95% CI = 1.353-6.763; P = 0.007) were independent risk factors for perioperative MI, stroke, and death. CONCLUSIONS: According to this single-center experience, CAS may effectively prevent and treat carotid artery stenosis that would otherwise lead to stroke. Being symptomatic and having a neurological deficit (mRS ≥3) increased the risk of perioperative MI, stroke, and death.

[Correlative study of carotid transient ischemic attacks and intracranial or extracranial angiostenosis].

OBJECTIVE: To investigate the relationship between the clinical features of carotid transient ischemic attacks (TIA) and the intracranial or extracranial angiostenosis. METHODS: Location and degree of stenosis of involved arteries were examined by the digital subtraction angiography in 52 patients with carotid TIA. RESULTS: Intracranial or extracranial vascular lesions of different degrees were revealed in 45 patients (86.5%), and 29 out of 45 (64.4%) had more than one site. Severe stenosis and occlusion occurred more frequently in TIA patients with short duration (less than 1 hour) and multiple attacks (more than twice). CONCLUSION: Most patients with TIA of carotid systems have stenosis in intracranial or extracranial arteries. TIA with short duration and multiple attacks always accompany with severe stenosis or occlusion in intracranial or extracranial arteries. Digital subtraction angiography helps to identify the vascular etiology of TIA and provides the instruction of therapeutic regimen.

[Evaluation by perfusion-weighted magnetic resonance to hemodynamic character and surgical effect of carotid system stenoses or occlusion].

OBJECTIVE: To evaluate hemodynamic character and surgical effect of stenoses or occlusion of carotid artery system by perfusion-weighted MRI. METHODS: Twenty-one patients with stenoses or occlusion of carotid artery system underwent surgical treatment. Two patients underwent endarterectomy, extracranial-intracranial arterial bypass to 10 patients, and percutaneous stent angioplasty to 9 patients. RESULTS: Preoperative perfusion-weighted magnetic resonance (MR) revealed normal regional cerebral blood flow in all patients, with delayed time to peak in both middle cerebral artery distribution and border zone. Postoperative perfusion-weighted MR revealed normal time to peak in border zone, but abnormal in middle cerebral artery distribution. Evaluated by perfusion-weighted MR, it showed that surgical method can improve the hemodynamic disorder of this kind of disease. The early curative effect of endarterectomy and percutaneous stent angioplasty is better than extracranial-intracranial arterial bypass. CONCLUSIONS: Perfusion-weighted MR is a good method to evaluate hemodynamic character of stenoses or occlusion of carotid artery system. Surgical method is helpful to this kind of disease, and its curative effect can be evaluated impersonally and accurately by this new technique.

[Percutaneous transluminal stenting for stenosis of internal carotid artery: a report of 355 cases].

OBJECTIVE: To discuss the benefits and complications of percutaneous transluminal stenting for stenosis of internal carotid artery (ICA). METHODS: 355 patients with ICA stenosis were included from 1997 to 2003. All of them took periprocedual anticoagulation treatment, cerebral vascular angiography and cervical Doppler sonography. 72 patients used cerebral protection of filter devices. Among the 283 patients without cerebral protection 202 patients (71.38%) underwent predilation, 66 patients (23.32%) underwent postdilation; and 3 patients underwent neither. RESULTS: The heart rates of 25.0% of all the patients decreased. Dislocation of microemboli happened in 5 patients. 2 of them improved after treatment. 3 of them got dyskinesia of one side. 2 patients (0.56%) died of intracerebral hemorrhage (ICH). 256 patients (84.77%) turned for the better. 260 patients (73.34%) were followed up. Restenosis occurred in 11 patients (4.23%). CONCLUSION: Percutaneous transluminal stenting for stenosis of internal carotid artery is safe if proper periprocedual treatment and operative procedure are taken. However, enough attention should be paid to the occurrence of ICH resulting from over-flow after operation.

[Complications of stent-assistant angioplasty of symptomatic intracranial artery stenosis].

OBJECTIVE: To discuss the safety of intracranial stenting for refractory symptomatic intracranial artery stenosis. METHODS: Forty-eight patients with symptomatic intracranial artery stenosis were treated by transluminal stent-assistant angioplasty. Of them, 40 cases were selected because they had recurrent TIAs or mild stroke despite of antiplatelet or anticoagulation therapy; 8 cases with high-grade stenosis after acute cerebral artery theromblysis. Lesions involved MCA (17/48); Basilar artery (8/48); intracranial vertebral artery (18/18); and distal ICA (5/18). RESULTS: For 46 of 48 cases the flexible coronary stent were successfully deployed. The average stenosis reduced from 83% to 5%, short-term follow-up showed good clinical improvement. Complications include vessel rupture (1/18); acute thrombosis within stent (1/48); perforation of cortical artery (1/18) and perforate vessel occlusion (1/18). CONCLUSION: Stent-assistant angioplasty are effective for treatment of symptomatic intracranial stenosis, the higher rate of complications may be because of the limited experiences of this technique. it need further practise and long term follow-up study.

[Combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke institute of brain vascular diseases].

OBJECTIVE: To test feasibility, safety and efficacy of combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke. METHODS: From 2001-5 to 2002-8, 19 patients with acute onset of stroke were treated with intraaterial thrombolysis followed by intra-cerebral stent. 9 located in middle cerebral artery (MCA), 10 located in basal artery (BA). For each patient, intraarterial thrombolysis of MCA or BA was applied at first, stent angioplasty was applied at the stenosis left after the thrombolysis by using the stent for coronary artery. RESULTS: All the 19 patients left stenosis after intraaterial thrombolysis, and the average stenosis was 85% in diameter. After the operation of stent, the images showed the vascular is smooth and had no stenosis left. The symptoms were disappeared or improved. Thrombus formation in the stent occurred on 1 patient 24 hours after the operation. TIA never occurred in the left 18 patients then. TCD follow up showed blood flow is normal. CONCLUSIONS: It is feasibility of intraaterial thrombosis followed by intra-cerebral stent. And it is valid for preventing occlusion again of the vessel and decreasing the rate of TIA occurring.