Systematic Review of Radiographic and Symptomatic Brain Infarcts in Carotid Artery Interventions and Cerebral Angiography

You'll want to know this if you are having a carotid procedure, I'm glad my carotid is totally closed up, although you don't see that as a solution to carotid problems.

Systematic Review of Radiographic and Symptomatic Brain Infarcts in Carotid Artery Interventions and Cerebral Angiography

1. Sung Cho₁,₂,
2. Abhishek Deshpande₁,₂,
3. Vinay Pasupuleti₁,₂,
4. Adrian Diaz₁,₂ and
5. Ken Uchino₁,₂

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1. Published online before print April 8, 2015, Neurology April 5, 2016 vol. 86 no. 16 Supplement P1.230

• Abstract

Abstract

Objective: To describe the rates of radiographic brain infarcts and clinical strokes in cerebral and carotid procedures. Introduction: Reports vary in incidence of silent brain infarcts after cerebrovascular procedures. In a systematic review we compared rates of radiographic brain infarcts (RBI) and clinical strokes in cerebral and carotid procedures: diagnostic cerebral angiography, carotid endarterectomy (CEA), and carotid stenting (CAS). Methods: We searched MEDLINE and 4 other databases for subject headings and text related to brain infarcts in carotid artery interventions from inception through February 2015. We included articles with cerebral angiography and carotid interventions if brain MRI was performed systematically, RBI and stroke incidence were reported. Results: Of 6332 articles retrieved, 77 studies (7296 patients) met the inclusion criteria. There were 12 cohorts in cerebral angiography, 26 in CEA, 39 in CAS with distal protection, 8 in CAS with proximal protection with or without flow reversal, 10 in CAS with unspecified devices and 10 in CAS without protection. MRI diffusion-weighted imaging scan was performed pre-procedure in 75 studies and post-procedure in all studies. The incidence of RBI and strokes in cerebral angiography were 20[percnt] (262/1314) and 1.4[percnt] (18/1314). CEA had lower incidence of RBI compared to CAS (15.9[percnt] (239/1524) vs 34.0[percnt] (1522/4482), p<0.001) but not of strokes (2.5[percnt] (37/1500) vs 3.4[percnt] (154/4482), p=0.07). Across the procedures, one out of 9.7 RBIs were symptomatic. RBI incidences differed among embolism protection methods in CAS: 24.3[percnt] (70/288) in proximal protection, 35.7[percnt] (740/2075) in distal protection, 32.6[percnt] (489/1502) in unspecified devices, and 36.1[percnt] (223/617) without protection; incidence of stroke were not significantly different among the procedures with 2.4[percnt] (7/288), 3.3[percnt] (69/2075), 3.1[percnt] (46/1502), and 5.2[percnt] (32/617), respectively. Conclusion: Only 1 of 10 periprocedural RBI during carotid revascularization or diagnostic angiography were symptomatic. CEA has a lower incidence of RBI compared to CAS.