Ahmet Güner1, Ömer Çelik1, Ahmet Arif Yalçın1, Murat Örten2, Serkan Kahraman1, Macit Kalçık3, Ezgi Gültekin Güner1, Çağdaş Topel4, Mehmet Ertürk1

1University Of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training And Research Hospital, Cardiology, İstanbul, Turkey
2University Of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training And Research Hospital, Neurology, İstanbul, Turkey
3Hitit University, Cardiology, Çorum, Turkey
4Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training And Research Hospital, Radiology, İstanbul, Turkey

Keywords: carotid stenting, cerebral embolism, nutritional status, prognostic nutrition index

Abstract

Objectives: Cerebral embolism after carotid artery stenting (CAS) remains a matter of concern in frailty patients. 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 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.