Prognostic nutrition index may predict cerebral embolic events following carotid artery stenting procedure

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.

Prognostic analysis of different therapeutic regimens in patients with acute cardiogenic cerebral embolism

Background Few studies focused on the functional outcomes of patients at 3 months after receiving intravenous thrombolysis, anticoagulation, or antiplatelet therapy within 4.5 h of onset of the cardiogenic cerebral embolism (CCE) subtype. Methods The purpose of this retrospective study was to analyse the clinical data of patients with acute CCE and compare the 3-month functional prognoses of patients after administration of different antithrombotic therapies within 4.5 h of stroke onset. A total of 335 patients with CCE hospitalized in our institution were included in this study. The patients were stratified according to the hyperacute treatment received, and baseline clinical and laboratory data were analysed. A 3-month modified Rankin scale (mRS) score of 0–2 was defined as an excellent functional outcome. Results A total of 335 patients were divided into thrombolytic (n = 78), anticoagulant (n = 88), and antiplatelet therapy groups (n = 169). A total of 164 patients had a good prognosis at 3 months (mRS ≤ 2). After adjustments were made for age and National Institute of Health Stroke Scale (NIHSS) score, each group comprised 38 patients, and there were no significant differences in sex composition, complications, lesion characteristics, or Oxfordshire Community Stroke Project (OSCP) classification among the three groups. The plasma D-dimer level (µg/ml) in the thrombolytic group was significantly higher than those in the anticoagulant and antiplatelet groups [3.07 (1.50,5.62), 1.33 (0.95,1.89), 1.61 (0.76,2.96), P < 0.001]. After one week of treatment, the reduction in NIHSS in the thrombolytic group was significantly greater than those in the other two groups [3.00 (1.00, 8.00), 1.00 (0.00, 5.00), 1.00 (0.00, 2.00), P = 0.025]. A total of 47 patients (41.2 %) had an mRS score of ≤ 2 at 3 months, and 23 patients died (20.2 %). There was no significant difference in the proportion of patients with a good prognosis or the mortality rate among the three groups (P = 0.363, P = 0.683). Conclusions Thrombolytic therapy is effective at improving short-term and 3-month prognoses. Anticoagulant therapy may be a safe and effective treatment option for patients with the cardiac stroke subtype who fail to receive intravenous recombinant tissue plasminogen activator (r-tPA) thrombolysis within 4.5 h in addition to antiplatelet therapy, as recommended by the guidelines.

BioGlue cerebral embolism following acute type A aortic dissection repair

The outcomes of surgery for Acute Stanford type A aortic dissection (ATAAD) have significantly improved in recent decades due to advances in surgical techniques and, surgical adhesives such as BioGlue. However, this convenient material can sometimes cause complications such as thrombotic embolism and pseudoaneurysm. Here, we present the case of a 61-year-old male with ATAAD who successfully underwent total arch replacement. Five days after the surgery, he collapsed due to right hemiplegia. We immediately performed cerebral thrombectomy and removed the thrombotic embolus caused by BioGlue, which was used to obliterate the false lumen of the dissected aorta during ATAAD repair.