Higher risk of silent infarction in the brain on MRI after carotid angioplasty and stenting in comparison with carotid endarterectomy
Silent infarction in the brain can be detected in around 34% of patients after carotid endarterectomy ( CEA ) and 54% after carotid angioplasty and stenting ( CAS ).
A study has compared the risk of new infarctions in the brain in patients undergoing CEA or CAS.
Consecutive patients with internal carotid artery ( ICA ) stenosis exceeding 70% were screened for inclusion in this prospective study.
Patients with indications for intervention, and eligible for both methods, were allocated randomly to CEA or CAS.
Neurological examination, cognitive function tests and MRI of the brain were undertaken before and 24 h after intervention.
Of 150 randomized patients, 73 ( 47 men; mean age 64.9 years ) underwent CEA and 77 ( 58 men; 66.4 years ) had CAS.
New infarctions on MRI were found more frequently after CAS ( 49 versus 25%; P = 0.002 ).
Lesion volume was also significantly greater after CAS ( P = 0.010 ).
Multiple logistic regression analyses identified intervention in the right ICA as the only independent predictor of brain infarction ( odds ratio, OR=2.10, 95% c.i. 1.03 to 4.25; P = 0.040 ).
Stroke or transient ischaemic attack occurred in one patient after carotid endarterectomy and in two after carotid angioplasty and stenting.
No significant differences were found in cognitive test results between the groups.
In conclusion, these data confirm a higher risk of silent infarction in the brain on MRI after carotid angioplasty and stenting in comparison with carotid endarterectomy, but without measurable change in cognitive function. ( Xagena )
Kuliha M et al, Br J Surg 2015;102:194-201
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