Laura Capoccia1, Pasqualino Sirignano2, Wassim Mansour3, Alessandro d'Adamo3, Enrico Sbarigia4, Paola Mariani5, Claudio Di Biasi6, Francesco Speziale7. 1. Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "La Sapienza" University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy. Electronic address: laura.capoccia@uniroma1.it. 2. Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "La Sapienza" University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy. Electronic address: pasqualino.sirignano@uniroma1.it. 3. Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "La Sapienza" University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy. 4. Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "La Sapienza" University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy. Electronic address: enrico.sbarigia@uniroma1.it. 5. Clinical Pathology Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "La Sapienza" University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy. Electronic address: paola.mariani@uniroma1.it. 6. Department of Radiology, Policlinico Umberto I, "La Sapienza" University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy. Electronic address: claudio.dibiasi@uniroma1.it. 7. Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "La Sapienza" University of Rome, 155 Viale del Policlinico, 00161 Rome, Italy. Electronic address: francesco.speziale@uniroma1.it.
Abstract
BACKGROUND: Aim of this study was to evaluate peri-procedural incidence of new diffusion-weighted-magnetic-resonance-imaging (DWMRI) brain lesions in CAS patients treated bycarotid mesh stent (CGuard™) or closed-cell stent (Wallstent™). METHODS:Consecutive patients with asymptomatic carotid stenosis ≥ 70% were submitted to preoperative DW-MRI scan, to exclude the presence of preoperative silent cerebral lesions. Patients were randomized to CGuard or Wallstent. DWMRI was performed immediately after the intervention and at 72-hour postoperatively. Moreover, pre and postoperative Mini-Mental-State-Examination Test (MMSE) and a Montreal-Cognitive-Assessment (MoCA) test were conducted, and S100β and NSE neurobiomarkers were measured at 5-time points (preoperatively, 2, 12, 24, and 48 h postoperatively). RESULTS:From January 2015 to October 2016, sixty-one consecutive eligible patients were submitted to preoperative DWMRI scan. Three patients were excluded because of preoperative silent cerebral lesions. In 29 CGuard patients, 1 developed a minor stroke and 8 silent new lesions were observed in the 72 h-DWMRI (31%): 4 lesions were ipsilateral, and 4 lesions were contra or bilateral. In 29 Wallstent patients, 7 clinically-silent new lesions were found in the 72 h-DWMRI (24.1%; p = 0.38). In 4 cases lesions were ipsilateral and in 3 cases contra or bilateral. S100B values doubled at 48 h in 24 patients, and among them 12 presented new DWMRI lesions. 48-h S100B increase was significantly related to 72-h DWMRI lesions (p = 0.012). CONCLUSIONS: In our experience both stents showed an acceptable rate of subclinical neurological events with no significant differences at 72-hour DWMRI between groups. Bilateral/contralateral lesions suggest that periprocedural neurological damage may have extra-carotid sources.
RCT Entities:
BACKGROUND: Aim of this study was to evaluate peri-procedural incidence of new diffusion-weighted-magnetic-resonance-imaging (DWMRI) brain lesions in CASpatients treated by carotid mesh stent (CGuard™) or closed-cell stent (Wallstent™). METHODS: Consecutive patients with asymptomatic carotid stenosis ≥ 70% were submitted to preoperative DW-MRI scan, to exclude the presence of preoperative silent cerebral lesions. Patients were randomized to CGuard or Wallstent. DWMRI was performed immediately after the intervention and at 72-hour postoperatively. Moreover, pre and postoperative Mini-Mental-State-Examination Test (MMSE) and a Montreal-Cognitive-Assessment (MoCA) test were conducted, and S100β and NSE neurobiomarkers were measured at 5-time points (preoperatively, 2, 12, 24, and 48 h postoperatively). RESULTS: From January 2015 to October 2016, sixty-one consecutive eligible patients were submitted to preoperative DWMRI scan. Three patients were excluded because of preoperative silent cerebral lesions. In 29 CGuard patients, 1 developed a minor stroke and 8 silent new lesions were observed in the 72 h-DWMRI (31%): 4 lesions were ipsilateral, and 4 lesions were contra or bilateral. In 29 Wallstent patients, 7 clinically-silent new lesions were found in the 72 h-DWMRI (24.1%; p = 0.38). In 4 cases lesions were ipsilateral and in 3 cases contra or bilateral. S100B values doubled at 48 h in 24 patients, and among them 12 presented new DWMRI lesions. 48-h S100B increase was significantly related to 72-h DWMRI lesions (p = 0.012). CONCLUSIONS: In our experience both stents showed an acceptable rate of subclinical neurological events with no significant differences at 72-hour DWMRI between groups. Bilateral/contralateral lesions suggest that periprocedural neurological damage may have extra-carotid sources.
Authors: Ján Sýkora; Kamil Zeleňák; Martin Vorčák; Martin Števík; Martina Sýkorová; Jozef Sivák; Marek Rovňák; Jana Zapletalová; Juraj Mužík; Igor Šinák; Egon Kurča; Lukas Meyer; Jens Fiehler Journal: Cardiovasc Intervent Radiol Date: 2022-07-07 Impact factor: 2.797
Authors: Adam Mazurek; Krzysztof Malinowski; Kenneth Rosenfield; Laura Capoccia; Francesco Speziale; Gianmarco de Donato; Carlo Setacci; Christian Wissgott; Pasqualino Sirignano; Lukasz Tekieli; Andrey Karpenko; Waclaw Kuczmik; Eugenio Stabile; David Christopher Metzger; Max Amor; Adnan H Siddiqui; Antonio Micari; Piotr Pieniążek; Alberto Cremonesi; Joachim Schofer; Andrej Schmidt; Piotr Musialek Journal: J Clin Med Date: 2022-08-17 Impact factor: 4.964
Authors: Tomas Klail; Christoph Kurmann; Johannes Kaesmacher; Adnan Mujanovic; Eike I Piechowiak; Tomas Dobrocky; Sara Pilgram-Pastor; Adrian Scutelnic; Mirjam R Heldner; Jan Gralla; Pasquale Mordasini Journal: Clin Neuroradiol Date: 2022-09-07 Impact factor: 3.156