title: Impact of acute cerebral ischemic lesions and their volume on the revascularization outcome of symptomatic carotid stenosis.
abstract: The influence of acute cerebral ischemic lesions (CILs) on the revascularization outcome of symptomatic carotid stenosis has been scarcely investigated in the literature. This study evaluated the effect of CILs and their volume on the results of carotid revascularization in symptomatic patients.
  
  
  
  All patients with symptomatic carotid artery stenosis who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) between 2005 and 2014 were considered. CILs ipsilateral to the stenosis were identified in the preoperative cerebral computed tomography. The volume was quantified in mm3and correlated with 30-day rates of stroke and stroke/death by χ2, multivariate analysis, Pearson correlation, and receiver operating characteristic curves.
  
  
  
  A total of 489 symptomatic patients were treated by CEA (327 [67%]) or CAS (162 [33%]), 186 (38%) ≤2 weeks and 303 (62%) >2 weeks from symptom onset. CEA and CAS patients had statistically similar rates of stroke (3.3% vs 5.5%; P = .27) and stroke/death (3.8% vs 5.9%; P = .22). CILs were identified in 251 patients (53%) and were associated with similar stroke and stroke/death rate compared with patients without CIL (12 [4.8%] vs 8 [3.5%], P = .46; and 14 [5.6%] vs 8 [3.5%]; P = .26, respectively). The median CIL volume was 1000 mm3(interquartile range [IQR], 7000 mm3). Patients with postoperative stroke and stroke/death had a significantly higher preoperative CIL volume of 5100 mm3(IQR, 31,000 mm3) vs 1000 mm3(IQR, 7000 mm3; P = .01) and 4500 mm3(IQR, 17,450 mm3) vs 1000 mm3(IQR, 7000 mm3; P = .03), respectively. The receiver operating characteristic curve analysis showed a volume of 4000 mm3was predictive of postoperative stroke with 75% sensitivity and 63% specificity. A CIL volume ≥4000 mm3was an independent risk factor for postoperative stroke, with a stroke rate of 9.3% (n = 9) vs 1.9% (n = 3) for a CIL volume of <4000 mm3(odds ratio, 4.6; 95% confidence interval, 1.1-19.1; P = .03).
  
  
  
  CIL volume in symptomatic carotid stenosis seems to influence the 30-day outcome independently from the timing of carotid revascularization. A CIL volume of ≥4000 mm3could be considered a significant predictor for postoperative stroke after carotid revascularization.
authors.affiliation: Vascular Surgery, University of Bologna "Alma Mater Studiorum," Policlinico S. Orsola Malpighi, Bologna, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Pini
authors.affiliation: Vascular Surgery, University of Bologna "Alma Mater Studiorum," Policlinico S. Orsola Malpighi, Bologna, Italy. Electronic address: gianluca.faggioli@unibo.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Faggioli
authors.affiliation: Vascular Surgery, University of Bologna "Alma Mater Studiorum," Policlinico S. Orsola Malpighi, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Longhi
authors.affiliation: Vascular Surgery, University of Bologna "Alma Mater Studiorum," Policlinico S. Orsola Malpighi, Bologna, Italy.
authors.forename: Liborio
authors.initials: L
authors.lastname: Ferrante
authors.affiliation: Vascular Surgery, University of Bologna "Alma Mater Studiorum," Policlinico S. Orsola Malpighi, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vacirca
authors.affiliation: Vascular Surgery, University of Bologna "Alma Mater Studiorum," Policlinico S. Orsola Malpighi, Bologna, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Gallitto
authors.affiliation: Vascular Surgery, University of Bologna "Alma Mater Studiorum," Policlinico S. Orsola Malpighi, Bologna, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Gargiulo
authors.affiliation: Vascular Surgery, University of Bologna "Alma Mater Studiorum," Policlinico S. Orsola Malpighi, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D019540:Area Under Curve; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome