The search for reliable markers for increased carotid artery stenting-induced cerebral embolism

摘要

In all randomized controlled trials comparing carotid stenting (CAS) with carotid endarter-ectomy (CEA) in symptomatic patients, stenting failed to show equal effectiveness in perioperative stroke prevention as compared to CEA. Of note, the main driver of the observed difference in procedural outcome was a significantly higher number of minor strokes in the CAS group of the International Carotid Stenting Study (ICSS), while the number of major strokes and stroke-related death was not significantly different. Analyzing the most probable cause of these procedural minor strokes is warranted in order to make stenting safer and to ultimately facilitate appropriate selection of symptomatic patients who may safely undergo CAS. Furthermore, ICSS subgroup analyses showed a significantly higher number of procedure-induced new cerebral white matter lesions following CAS as compared to CEA.2 In this issue of the JEVT, Pini et al.3 studied several clinical and serological markers in relation to periproce-dural cerebral embolism in a small cohort of patients undergoing CAS. The authors found female gender and the presence of aortic plaque as clinical markers; representing inflammatory status, high-sensitivity C-reactive protein (hs-CRP) >5 mg/L and serum amyloid-A protein (SAA) >10 mg/L were serological predictors of increased cerebral embolism related to CAS.