Abstract：
BACKGROUND: Careful selection of patients for carotid stenting is necessary. We suggest that patients with a shaggy aorta syndrome may be at higher risk for perioperative embolic complications.
METHODS: The study is a retrospective subanalysis of the SIBERIA Trial. We included 72 patients undergoing transfemoral carotid artery stenting. Patients were monitored during the procedures using multifrequency transcranial Doppler with embolus detection and differentiation. Pre- and postprocedural (2 and 30 days) cerebral diffusion-weighted cerebral MRIs were performed.
RESULTS: Forty-six patients had shaggy aorta syndrome. Intraoperative embolisms were recorded in 82.6% and 46.1% of patients with and without shaggy aorta syndrome, respectively (P=0.001). New asymptomatic ischemic brain lesions in the postoperative period occurred in 78.3% and in 26.9% of patients with and without shaggy aorta syndrome, respectively (P<0.001). There were no cases of stroke within 2 days in both groups. 3 (6.5%) cases of stroke within 30 days after the procedure were observed only in patients with shaggy aorta syndrome. There were no cases of contralateral stroke. Shaggy aorta syndrome (OR 5.54 [1.83:16.7], P=0.001) and aortic arch ulceration (OR 6.67 [1.19: 37.3], P=0.02) were independently associated with cerebral embolism. Shaggy aorta syndrome (OR 9.77 [3.14-30.37], P<0.001) and aortic arch ulceration (OR 12.9 [2.3: 72.8], P=0.003) were independently associated with ipsilateral new asymptomatic ischemic brain lesions.
CONCLUSIONS: Shaggy aorta syndrome and aortic arch ulceration significantly increase the odds of intraoperative embolism and new asymptomatic ischemic brain lesions. Carotid endarterectomy or transcervical carotid stent should be selected in patients with shaggy aorta syndrome.
METHODS: The study is a retrospective subanalysis of the SIBERIA Trial. We included 72 patients undergoing transfemoral carotid artery stenting. Patients were monitored during the procedures using multifrequency transcranial Doppler with embolus detection and differentiation. Pre- and postprocedural (2 and 30 days) cerebral diffusion-weighted cerebral MRIs were performed.
RESULTS: Forty-six patients had shaggy aorta syndrome. Intraoperative embolisms were recorded in 82.6% and 46.1% of patients with and without shaggy aorta syndrome, respectively (P=0.001). New asymptomatic ischemic brain lesions in the postoperative period occurred in 78.3% and in 26.9% of patients with and without shaggy aorta syndrome, respectively (P<0.001). There were no cases of stroke within 2 days in both groups. 3 (6.5%) cases of stroke within 30 days after the procedure were observed only in patients with shaggy aorta syndrome. There were no cases of contralateral stroke. Shaggy aorta syndrome (OR 5.54 [1.83:16.7], P=0.001) and aortic arch ulceration (OR 6.67 [1.19: 37.3], P=0.02) were independently associated with cerebral embolism. Shaggy aorta syndrome (OR 9.77 [3.14-30.37], P<0.001) and aortic arch ulceration (OR 12.9 [2.3: 72.8], P=0.003) were independently associated with ipsilateral new asymptomatic ischemic brain lesions.
CONCLUSIONS: Shaggy aorta syndrome and aortic arch ulceration significantly increase the odds of intraoperative embolism and new asymptomatic ischemic brain lesions. Carotid endarterectomy or transcervical carotid stent should be selected in patients with shaggy aorta syndrome.
摘要：
背景：需要仔细选择颈动脉支架置入的患者。我们建议，患有shaggy主动脉综合征的患者可能发生围手术期栓塞并发症的风险更高。
方法：本研究是对SIBERIA试验的回顾性亚分析。我们纳入了72例接受经股颈动脉支架置入术的患者。在手术过程中使用多频经颅多普勒对患者进行了监测，并进行了栓子检测和鉴别。术前和术后（2天和30天）进行脑弥散加权脑MRI。
结果：46例患者出现了粗主动脉综合征。术中栓塞记录在82.6％和46.1％的有和没有shaggy主动脉综合征的患者中，分别(P=0.001)。术后新的无症状缺血性脑损伤发生在78.3％和26.9％的患者有和没有shagging主动脉综合征，分别(P<0.001)。2天内两组均无卒中病例。仅在患有shaggy主动脉综合征的患者中观察到3例（6.5％）在手术后30天内发生中风。没有对侧中风的病例。新生主动脉综合征（OR5.54[1.83:16.7]，P=0.001）和主动脉弓溃疡（OR6.67[1.19：37.3]，P=0.02）与脑栓塞独立相关。新生主动脉综合征（OR9.77[3.14-30.37]，P<0.001）和主动脉弓溃疡（OR12.9[2.3：72.8]，P=0.003）与同侧新的无症状缺血性脑损伤独立相关。
结论：Shaggy主动脉综合征和主动脉弓溃疡显著增加了术中栓塞和新的无症状缺血性脑损伤的几率。对于有shaggy主动脉综合征的患者，应选择颈动脉内膜切除术或颈动脉支架。
方法：本研究是对SIBERIA试验的回顾性亚分析。我们纳入了72例接受经股颈动脉支架置入术的患者。在手术过程中使用多频经颅多普勒对患者进行了监测，并进行了栓子检测和鉴别。术前和术后（2天和30天）进行脑弥散加权脑MRI。
结果：46例患者出现了粗主动脉综合征。术中栓塞记录在82.6％和46.1％的有和没有shaggy主动脉综合征的患者中，分别(P=0.001)。术后新的无症状缺血性脑损伤发生在78.3％和26.9％的患者有和没有shagging主动脉综合征，分别(P<0.001)。2天内两组均无卒中病例。仅在患有shaggy主动脉综合征的患者中观察到3例（6.5％）在手术后30天内发生中风。没有对侧中风的病例。新生主动脉综合征（OR5.54[1.83:16.7]，P=0.001）和主动脉弓溃疡（OR6.67[1.19：37.3]，P=0.02）与脑栓塞独立相关。新生主动脉综合征（OR9.77[3.14-30.37]，P<0.001）和主动脉弓溃疡（OR12.9[2.3：72.8]，P=0.003）与同侧新的无症状缺血性脑损伤独立相关。
结论：Shaggy主动脉综合征和主动脉弓溃疡显著增加了术中栓塞和新的无症状缺血性脑损伤的几率。对于有shaggy主动脉综合征的患者，应选择颈动脉内膜切除术或颈动脉支架。
