Prognostic Nutrition Index May Predict Cerebral Embolic Events Following Carotid Artery Stenting Procedure

Yıl 2022, Cilt: 25 Sayı: 1, 40 - 49, 18.04.2022

Ahmet Güner Ömer Çelik Ahmet Arif Yalçın Murat Örten Serkan Kahraman Macit Kalçık Ezgi Gültekin Güner Çağdaş Topel Mehmet Ertürk

Öz

Introduction: Cerebral embolism after carotid artery stenting (CAS) remains a matter of concern in frailty patients. The prognostic nutrition index (PNI), which provides an objective assessment of nutritional status, is a useful prognostic indicator in cardiovascular diseases. We aim to determine the value of pre-procedural PNI in predicting cerebral embolism including stroke, transient ischemic attack (TIA), and silent new ischemic cerebral lesions (SNICLs).

Patients and Methods: We retrospectively evaluated 138 patients (mean age= 70.6 ± 6.7 years, male= 99) who underwent CAS. Inclusion criteria were as follows: i) availability of all medical records including albumin value and lymphocyte count, ii) having cranial imaging after CAS, iii) having symptomatic carotid stenosis 50-99% or asymptomatic carotid stenosis ≥60-99%. The study population was divided into two subgroups according to the presence of cerebral embolism as cerebral embolism (+) cerebral embolism (-) groups.

Results: Among the study population, 22 patients (16%) had at least 1 SNICL, seven patients (5.0%) had an ischemic stroke, and five patients (3.6%) had TIA. The cerebral embolism (+) group had a significantly lower PNI, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the cerebral embolism (-) group. Low PNI was identified as one of the independent predictors of cerebral embolism (OR= 0.808; 95% CI= 0.670-0.975; p= 0.026), and PNI lower than 44.7 predicted cerebral embolism with a sensitivity of 70.6% and a specificity of 61.1% (AUC= 0.739; 95% CI= 0.651 to 0.827; p< 0.001).

Conclusion: The current data suggest that PNI is an independent prognostic factor for cerebral embolic complications after CAS procedures.

Anahtar Kelimeler

Stroke, magnetic resonance imaging, carotid artery, stent endovascular

Kaynakça

• 1. Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association
• 2. Karaduman BD, Ayhan H, Keleş T, Bozkurt E. Efficacy and safety of carotid artery stenting: Experience of a single center Turk Kardiyol Dern Ars 2020;48:646-55.
• 3. Müller MD, Lyrer PA, Brown MM, Bonati LH. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Stroke 2021;52:e3-e5.
• 4. Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzge DG, et al. Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med 2016;374:1011-20. [Crossref]
• 5. Gurm HS, Yadav JS, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med 2008;358:1572-9. [Crossref]
• 6. Güner A, Çelik Ö, Topel Ç, Arif Yalçın A, Kalçık M, Uzun F, et al. The effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures (from the COMPLEX-CAS Trial). Vascular 2021:17085381211010016. [Crossref]
• 7. Xu X, Feng Y, Bai X, Ma Y, Wang Y, Chen Y, et al. Risk factors for silent new ischemic cerebral lesions following carotid artery stenting. Neuroradiology 2020;62:1177-84. [Crossref]
• 8. Bendszus M, Stoll G. Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures. Lancet Neurol 2006;5:364-72. [Crossref]
• 9. Öcal L, Küp A, Keskin M, Cerşit S, Çelik M, Eren H, et al. Prognostic significance of pre-procedural prognostic nutritional index in patients with carotid artery stenting. J Stroke Cerebrovasc Dis 2020;29:104932. [Crossref]
• 10. Kahraman S, Zencirkıran Aguş H, Kalkan AK, Uzun F, Ertürk M, Kalkan ME, et al. Prognostic nutritional index predicts mortality in infective endocarditis. Turk Kardiyol Dern Ars 2020;48:392-402. [Crossref]
• 11. Kurmus O, Aslan T, Eren M, Akbuga K, Erkan AF, Ekici B, et al. Nutritional status and severity of coronary artery disease. Coron Artery Dis 2021. [Crossref]
• 12. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980;139:160-7. [Crossref]
• 13. Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1998;339:1415-25. [Crossref]
• 14. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. American Heart Association; American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Interdisciplinary Council on Peripheral Vascular Disease. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council
• 15. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Buddy Connors JB, Culebras A, et al. American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Peripheral Vascular Disease; Council on Nutrition, Physical Activity and Metabolism. An updated definition of stroke for the 21st century
• 16. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018;49:e46-e110. [Crossref]
• 17. Giallauria F, Di Lorenzo A, Venturini E, Pacileo M, D’Andrea A, Garofalo U, et al. Frailty in acute and chronic coronary syndrome patients entering cardiac rehabilitation. J Clin Med 2021;10:1696. [Crossref]
• 18. Zahn R, Ischinger T, Hochadel M, Zeymer U, Schmalz W, Treese N, et al. Carotid artery stenting in octogenarians: results fromthe ALKK Carotid Artery Stent (CAS) Registry. Eur Heart J 2007;28:370-5. [Crossref]
• 19. Faateh M, Kuo PL, Dakour-Aridi H, Aurshina A, Locham S, Malas M. Frailty as a predictor of outcomes for patients undergoing carotid artery stenting. J Vasc Surg. 2021;S0741-5214(21):00618-2. [Crossref]
• 20. Mandelbaum AD, Hadaya J, Ulloa JG, Patel R, McCallum JC, De Virgilio C, et al. Impact of frailty on clinical outcomes after carotid artery revascularization. Ann Vasc Surg 2021;S0890-5096(21)00099-6. [Crossref]
• 21. Gürbak İ, Güner A, Güler A, Şahin AA, Çelik Ö, Uzun F, et al. Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition-SAVR trial). J Card Surg 2021;36:1872-81. [Crossref]
• 22. Candeloro M, Di Nisio M, Balducci M, Genova S, Valeriani E, Pierdomenico SD, et al. Prognostic nutritional index in elderly patients hospitalized for acute heart failure. ESC Heart Fail 2020;7:2479-84. [Crossref]
• 23. Caliskan Z, Tatlisu MA, Kahraman R, Gokturk S, Sayar S, Kostek O, et al. The impact of prognostic nutritional index on coronary flow reserve in patients with inflammatory bowel disease. Medeni Med J 2019;34:271-7. [Crossref]
• 24. Keskin M, Hayıroglu MI, Keskin T, Kaya A, Tatlısu MA, Altay Servet, et al. A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index. Nutr Metabol Cardiovasc Dis 2017;27:438-46. [Crossref]
• 25. Keskin M, Ipek G, Aldag M, Altay S, Hayıroğlu Mİ, Börklü EB, et al. Effect of nutritional status on mortality in a patient undergoing coronary artery bypass grafting. Nutrition 2018;48:82-6. [Crossref]
• 26. Hayiroglu MI, Keskin M, Keskin T, Uzun AO, Altay S, Kaya A, et al. A novel independent survival predictor in pulmonary embolism: prognostic nutritional index. Clin Appl Thromb Hemost 2018;24:633-9. [Crossref]
• 27. Peng F, Chen W, Zhou W, Li P, Niu H, Chen Y, et al. Low prognostic nutritional index associated with cardiovascular disease mortality in incident peritoneal dialysis patients. Int Urol Nephrol 2017;49:1095-101. [Crossref]
• 28. Dong X, Wang B, Chen S, Liu J, Xia Y, Wang S, et al. Association between prognostic nutritional index and contrast-associated acute kidney injury in patients complicated with chronic kidney disease and coronary artery disease. J Interv Cardiol 2021;2021:2274430. [Crossref]
• 29. Teker Açıkel ME, Korkut AK. Impact of Controlling Nutritional Status Score (CONUT) and Prognostic Nutritional Index (PIN) on patients undergoing coronary artery bypass graft surgery. Heart Surg Forum 2019;22: E294-E297. [Crossref]
• 30. Tai IH, Wu PL, Guo MM, Lee J, Chu CH, Hsieh KS, et al. Prognostic nutrition index as a predictor of coronary artery aneurysm in Kawasaki Disease. BMC Pediatr 2020;20:203. [Crossref]
• 31. Shen H, Dai Z, Wang M. Preprocedural neutrophil to albumin ratio predicts in-stent restenosis following carotid angioplasty and stenting. J Stroke Cerebrovasc Dis 2019;28:2442-7. [Crossref]
• 32. Stone PA, Thompson SN, Khan M, Northfield E, Schillinger R, Skaff P. The impact of biochemical markers on major adverse cardiovascular events and contralateral carotid artery stenosis progression following carotid interventions. Ann Vasc Surg 2017;38:144-50. [Crossref]
• 33. Conway AM, Nguyen Tran NT, Qato K, Ehidom C, Stoffels GJ, Giongola G, et al. Complexity of aortic arch anatomy affects the outcomes of transcarotid artery revascularization versus transfemoral carotid artery stenting.Ann Vasc Surg 2020;67:78-89. [Crossref]
• 34. Huibers A, Calvet D, Kennedy F, Czuriga-Kovács KR, Featherstone RL, Moll FL, et al. Mechanism of procedural stroke following carotid endarterectomy or carotid artery stenting within the International Carotid Stenting Study (ICSS) randomised trial. Eur J Vasc Endovasc Surg 2015;50:281-8. [Crossref]
• 35. Faggioli G, Ferri M, Gargiulo M, Freyrie A, Fratesi F, Manzoli L, et al. Measurement and impact of proximal and distal tortuosity in carotid stenting procedures. J Vasc Surg 2007;46:1119-24. [Crossref]
• 36. Naggara O, Touzé E, Beyssen B, Trinquart L, Chatellier G, Meder JF, et al. Anatomical and technical factors associated with stroke or death during carotid angioplasty and stenting: results from the endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) trial and systematic review. Stroke 2011;42:380-8. [Crossref]
• 37. Bijuklic K, Wandler A, Hazizi F, Schofer J. The PROFI Study (prevention of cerebral embolization by proximal balloon occlusion compared to filter protection during carotid artery stenting): a prospective randomized trial. J Am Coll Cardiol 2012;59:1383-9. [Crossref]
• 38. Akkaya E, Vuruskan E, Gul ZB, Yildirim A, Pusuroglu H, Surgit O, et al. Cerebral microemboli and neurocognitive change after carotid artery stenting with different embolic protection devices. Int J Cardiol 2014;176:478-83. [Crossref]
• 39. Hitchner E, Baughman BD, Soman S, Long B, Rosen A, Zhou W. Microembolization is associated with transient cognitive decline in patients undergoing carotid interventions. J Vasc Surg 2016;64:1719-25. [Crossref]