Prognostic Nutrition Index May Predict Cerebral Embolic Events Following Carotid Artery Stenting Procedure
Ahmet Güner1
, Ömer Çelik1, Ahmet Arif Yalçın1, Murat Örten2, Serkan Kahraman1, Macit Kalçık3, Ezgi Gültekin Güner1, Çağdaş Topel4, Mehmet Ertürk1
1Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital University of Health Sciences, İstanbul, Turkey
2Clinic of Neurology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
3Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
4Clinic of Radiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
Keywords: Stroke; magnetic resonance imaging; carotid artery; stent endovascular
Abstract
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.
The approval for this study was obtained from İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Clinical Research Ethics Committee (Decision no: 2021/11, Date: 23.02.2021).
This is retrospective study, we could not obtain written informed consent from the participants.
Externally peer-reviewed.
Concept/Design - AG; Analysis/Interpretation - AG, EGG, MÖ, CA, MK; Data Collection - All of authors; Writing - AG; Critical Revision - ME; Final Approval - AG; Statistical Analysis - AG, MK; Overall Responsibility - AG, FU, AKK, SK, ÖÇ, ME.
The authors declared that there was no conflict of interest during the preparation and publication of this article.
The authors declared that this study has received no financial support.