title: Distal embolisation during carotid stenting is predicted by circulating levels of LDL cholesterol and C-reactive protein.
abstract: OBJECTIVE
  Distal embolisation during carotid artery stenting (CAS) is the main cause of cerebral complications; thus, the amount of embolisation occurring during CAS can be considered as a surrogate endpoint of cerebral complications. Our aim was to find patient characteristics which are associated with a higher risk of embolisation during CAS.
  
  
  RESULTS
  From January to December 2010 all consecutive patients undergoing CAS with embolic protection at three medium- to high-volume Italian centres were prospectively enrolled in this multicentre study. After CAS, the embolic debris was classified by visual inspection into two groups: "scarce" (no debris or hardly visible debris), and "relevant" (visible embolic debris) embolisation. Two hundred and thirty-six consecutive patients (79% males, 32.7% symptomatic) were enrolled. Open cell stents were used in 52.7% of the patients, distal filters were employed in 85.5% and proximal protection in 14.5%. Procedural success was achieved in 100% of procedures. Relevant embolisation was observed in 16.1% of patients, including those who suffered all the periprocedural complications (4.2%). At multivariate statistical analysis, high circulating LDL cholesterol and C-reactive protein levels were the only factors associated with relevant embolisation.
  
  
  CONCLUSIONS
  In this study, high circulating LDL cholesterol and C-reactive protein levels were associated with relevant embolisation after CAS, opening up the hypothesis that therapy with statins before elective CAS may reduce plaque embolisation and improve outcome. (EudraCT number: 016737-95).
authors.affiliation: Interventional Cardiology, A.O. Fatebenefratelli, Milan, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Cortese
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Sara
authors.initials: S
authors.lastname: De Matteis
authors.forename: Antonio
authors.initials: A
authors.lastname: Rizza
authors.forename: Danilo
authors.initials: D
authors.lastname: Giannini
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.forename: Alberto
authors.initials: A
authors.lastname: Balbarini
authors.forename: Steve
authors.initials: S
authors.lastname: Ramee
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D016893:Carotid Stenosis / Q000175:diagnosis*; D008078:Cholesterol, LDL / Q000097:blood*; D057505:Embolic Protection Devices / Q000009:adverse effects*; D004617:Embolism / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*
chemical_list: D008078:Cholesterol, LDL; D002097:C-Reactive Protein