Predictors of embolic complications during carotid stenting (tactile trial)

Background. In 30% to 87% patients undergoing carotid artery stenting (CAS), new ischaemic lesions (NILs) of the brain are detected on magnetic resonance imaging (MRI). According to some authors, in 60% cases who undergo CAS via transfemoral (TF) access, NILs are also found in the contralateral and other vascular pools of the brain that are not directly related to the target carotid artery, most likely a result of the endovascular manipulation of the catheter on the aortic arch. An alternative access site for CAS is transradial (TR) access. Theoretically, with TR access, the catheter's contact with the aortic arch is reduced, particularly with an intervention on the right internal carotid artery, and the risk of embolic events is possibly reduced. However, this aspect has not yet been explored. Aim. The aim of this study was to identify the predictors of NILs of the brain in patients undergoing CAS via the TR and TF approaches. Methods. The study included 96 patients with indications for CAS. Patients were randomised in a 1:1 ratio to either the TR (n = 48) or TF (n = 48) groups. All patients underwent diffusion-weighted imaging MRI before and 12 to 24 hours after the procedure. Multiple logistic regression with step-by-step turning off of variables was used to determine the predictors of NIL. Results. A total of 40 clinical, demographic, instrumental and intraoperative variables were analysed. Based on the results of single regression analysis, 6 predictors (age, male sex, hypertension, history of percutaneous transluminal coronary angioplasty, intersection of the aortic arch and type II/III aortic arch) were included in the multivariate model. From the final multivariate analysis, it was found that age, intersection of the aortic arch and type II/III aortic arch are independent predictors of NILs after CAS. Conclusion. Patient age, type II/III aortic arch and need for a catheter to cross the aortic arch are independent predictors of NILs during carotid stenting.