期刊
JACC-CARDIOVASCULAR INTERVENTIONS
卷 1, 期 5, 页码 571-577出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2008.06.008
关键词
carotid artery disease; cerebral ischemia; magnetic resonance imaging; stents
Objectives This study sought to assess the timing of cerebral ischemia after emboli-protected carotid artery stenting (CAS). Background Predominantly clinically silent cerebral ischemia has been observed in up to 50% of patients undergoing emboli-protected CAS. The timing and location of cerebral ischemia has not been sufficiently elucidated. Methods In 58 patients (69.6 +/- 8.3 years) who underwent 59 procedures, diffusion-weighted magnetic resonance imaging (DWMRI) was performed before the intervention and at 2 time points (t(1) and t(2)) after the intervention. Results No patient showed recent cerebral injury before CAS. At t(1) = 3.5 +/- 1.8 h, new ischemic foci, all located in the ipsilateral hemisphere, were observed in 12 of 59 DWMRI studies (20.3%, 95% confidence interval: 11.0% to 32.8%). At t(2) = 18.0 +/- 3.1 h, 7 more DWMRI scans showed recent ischemic foci, and 3 scans in patients with positive scans at t(1) showed additional foci, for a total of 10 scans (17.0%, 95% confidence interval: 8.4% to 29.0%) documenting late cerebral ischemia. In 4 of these (40%), ischemic foci were located contralaterally. Cerebral ischemia was not associated with overt neurological sequelae out to 30 days in any patient. Conclusions The incidence of late cerebral ischemia occurring between 3.5 and 18 h after emboli-protected CAS was 17%. It may occur with equal likelihood in either hemisphere. Preventive measures to possibly reduce the incidence of cerebral embolization should focus not only on the target lesion, but also on the access vasculature. Patients should be monitored and DWMRI delayed for at least 18 h after the intervention. (J Am Coll Cardiol Intv 2008;1:571-7) (C) 2008 by the American College of Cardiology Foundation
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据