Vol. 24 No. 1 (2020)
Endovascular Surgery

Predictors of embolic complications during carotid stenting (TACTILE trial)

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  • D. Malaev,
  • A. Boykov,
  • A. Prohorihin,
  • A. Tarkova,
  • V. Baystrukov,
  • S. Fatulloeva,
  • E. Kretov
D. Malaev
Meshalkin National Medical Research Center, Novosibirsk
Bio
A. Boykov
Meshalkin National Medical Research Center, Novosibirsk
A. Prohorihin
Meshalkin National Medical Research Center, Novosibirsk
A. Tarkova
Meshalkin National Medical Research Center, Novosibirsk
V. Baystrukov
Meshalkin National Medical Research Center, Novosibirsk
S. Fatulloeva
Meshalkin National Medical Research Center, Novosibirsk
E. Kretov
Meshalkin National Medical Research Center, Novosibirsk
DOI: https://doi.org/10.21688/1681-3472-2020-1-28-36

Published 2020-04-07

Keywords

  • carotid stenting,
  • new ischaemic lesion,
  • transfemoral approach,
  • transradial approach

How to Cite

Malaev, D., Boykov, A., Prohorihin, A., Tarkova, A., Baystrukov, V., Fatulloeva, S., & Kretov, E. (2020). Predictors of embolic complications during carotid stenting (TACTILE trial). Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 24(1), 28–36. https://doi.org/10.21688/1681-3472-2020-1-28-36

Copyright (c) 2020 Malaev D.U., Boykov A.A., Prohorihin A.A., Tarkova A.R., Baystrukov V.I., Fatulloeva S.S., Kretov E.I.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

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.

Received 9 January 2020. Revised 21 February 2020. Accepted 25 February 2020.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

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