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Volume of acute cerebral ischemic lesions affects carotid revascularization outcomes

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Larger volume of acute cerebral ischemic lesions is associated with increased risk for stroke or death after endovascular or surgical carotid revascularization, according to new findings.

Researchers examined the relationship between cerebral ischemic lesions and outcomes after carotid revascularization in 489 symptomatic patients who underwent carotid artery stenting (CAS; 33%) or carotid endarterectomy (67%) between 2005 and 2014. Sixty-two percent of patients had their procedure more than 2 weeks after onset of symptoms.

The researchers identified cerebral ischemic lesions ipsilateral to the stenosis by cerebral CT in 251 patients (53%), quantified them by volume, and analyzed their association with 30-day stroke and 30-day stroke or death. Rodolfo Pini, MD, from University of Bologna, Italy, presented the findings at the Society of Vascular Surgery 2016 Vascular Annual Meeting.

Pini and colleagues found no difference between CAS and carotid endarterectomy in 30-day stroke rate (CAS, 5.5%; endarterectomy, 3.3%; P = .27) or in 30-day stroke or death rate (CAS, 5.9%; endarterectomy, 3.8%; P = .22).

Compared with patients without cerebral ischemic lesions, patents with them had similar rates of 30-day stroke (lesion group, 4.8%; no lesion group, 3.5%; P = .46) and 30-day stroke or death (lesion group, 5.6%; no lesion group, 3.5%; P = .26), according to the researchers.

However, when Pini and colleagues performed a Pearson correlation analysis, they found that volume of cerebral ischemic lesion correlated with 30-day stroke (r = 0.15; P = .02) and 30-day stroke or death (r = 0.14; P = .04).

In addition, the relationship between volume of cerebral ischemic lesion and 30-day stroke persisted independently of when the patient had their procedure (less than 2 weeks after symptom onset: r = 0.16; P = .03; more than 2 weeks: r = 0.21; P = .04), the researchers found.

Volume of cerebral ischemic lesion correlated with outcomes in patients who underwent CAS (30-day stroke: r = 0.27; P = .005; 30-day stroke or death: r = 0.24; P = .01), but not in those who had endarterectomy (30-day stroke: r = 0.05; P = .55; 30-day stroke or death: r = 0.03; P = .65), according to the researchers.

In a receiver operating characteristic curve analysis, cerebral ischemic lesion volume of at least 4,000 mm³ was an independent predictor of postoperative stroke (sensitivity, 75%; specificity, 63%; OR = 4.6; 95% CI, 1.1-19.1). – by Erik Swain

Reference:

Pini R, et al. Plenary Session 5: SS25. Presented at: Society of Vascular Surgery 2016 Vascular Annual Meeting; June 8-11, 2016; National Harbor, Md.

Disclosure: Pini reports no relevant financial disclosures.