Impact of coexisting coronary artery disease on the occurrence of cerebral ischemic lesions after carotid stenting

Kuo-Lun Huang; Yeu-Jhy Chang; Chien-Hung Chang; Ting-Yu Chang; Chi-Hung Liu; I-Chang Hsieh; Ho-Fai Wong; Yau-Yau Wai; Yu-Wei Chen; Bak-Sau Yip; Tsong-Hai Lee

doi:10.1371/journal.pone.0094280

Impact of coexisting coronary artery disease on the occurrence of cerebral ischemic lesions after carotid stenting

PLoS One. 2014 Apr 14;9(4):e94280. doi: 10.1371/journal.pone.0094280. eCollection 2014.

Authors

Affiliations

¹ Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
² Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan.
³ College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Internal Medicine, Section of Cardiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁴ College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁵ Department of Neurology, Landseed Hospital, Taoyuan, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei City, Taiwan; Department of Computer Science and Information Engineering, National Central University, Zhongli City, Taiwan.
⁶ Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.

Abstract

Background: Coronary artery disease (CAD) may coexist with extracranial carotid artery stenosis (ECAS), but the influence of CAD on procedure-related complications after carotid artery stenting (CAS) has not been well investigated. The study aimed to determine the impact of CAD on the occurrence of peri-CAS cerebral ischemic lesions on diffusion-weighted imaging (DWI) scanning.

Methods: Coronary angiography was performed within six months before CAS. DWI scanning was repetitively done within 1 week before and after CAS. Clinical outcome measures were stroke, angina, myocardial infarction and death within 30 days.

Results: Among 126 patients (69.5±9.0 years) recruited for unilateral protected CAS, 33 (26%) patients had peri-CAS DWI-positive lesions. CAD was noted in 79% (26 in 33) and 48% (45 in 93) of patients with and without peri-CAS DWI-positive lesions (OR, 4.0; 95% CI, 1.6-10.0; P = .0018), and the number of concomitant CAD on coronary angiography was positively correlated with the risk for peri-CAS DWI-positive lesions (P = .0032). In patients with no CAD (n = 55), asymptomatic CAD (n = 41) and symptomatic CAD (n = 30), the occurrence rates of peri-CAS DWI-positive lesions were 13%, 41% and 30% (P = .0048), and the peri-CAS stroke rates were 2%, 7% and 0% (P = .2120).

Conclusions: The severity of morphological CAD and the presence of either symptomatic or asymptomatic CAD are associated with the occurrence of peri-CAS cerebral ischemic lesions.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain Ischemia / etiology*
Carotid Arteries / pathology*
Coronary Artery Disease / complications*
Diffusion Magnetic Resonance Imaging
Female
Humans
Male
Stents / adverse effects*

Grants and funding

This study was carried out with financial support from the National Science Council, Taiwan (grant number 102-2314-B-182A-114-) and Chang Gung Memorial Hospital, Taiwan (grant CMRPG350733, CMRPG390821, CMRPG3B0612, CMRPG3A0352, and CMRPG3B0111). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.