抄録
Non-ipsilateral ischemic lesions after carotid artery stenting are considered to arise from emboli originating in the aortic arch, but the quantitative contribution of aortic arch calcification to post-carotid artery stenting ischemic lesions remains unclear. This study aimed to investigate the association between volumetric aortic arch calcification and non-ipsilateral diffusion-weighted imaging hyperintense lesions after transfemoral carotid artery stenting.
We retrospectively analyzed 99 consecutive transfemoral carotid artery stenting procedures performed between January 2018 and December 2023. Aortic arch calcification volume was quantified using preoperative computed tomography angiography using threshold-based segmentation. Postprocedural diffusion-weighted imaging performed within 48 h was assessed for hyperintense lesions in the contralateral hemisphere or cerebellum. Variables were evaluated using univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis was used to determine the optimal cut-off value for predicting non-ipsilateral lesions.
Non-ipsilateral high-intensity diffusion-weighted imaging lesions occurred in 14 patients (14.1%), who showed significantly higher aortic arch calcification volumes than did those without lesions (median 2.2 vs. 1.0 mL, p = 0.005). Receiver operating characteristic analysis identified an optimal cutoff of 1.3 mL (sensitivity 78.6%, specificity 62.3%, area under the curve 0.73). Both age (odds ratio 1.1 per year, p = 0.039) and aortic arch calcification volume (odds ratio 1.3 per mL, p = 0.040) were independently associated with non-ipsilateral lesions. Aortic arch type and guiding catheter size showed no significant associations. Quantitative aortic arch calcification on preoperative computed tomography angiography was independently associated with non-ipsilateral ischemic lesions after transfemoral carotid artery stenting. Incorporating calcification volume into preprocedural assessments may assist in selecting alternative access routes or protective strategies for patients at high risk.
