Silent cerebral infarction after percutaneous coronary intervention of chronic total occlusions (CTO) and non-CTOs.
Silent cerebral infarctions (SCI) determined by neuron specific enolase (NSE) elevation may develop more during chronic total occlusion (CTO) percutaneous coronary interventions (PCI) than non-CTO interventions. Our aim was to examine CTO and non-CTO PCIs for SCI development. 100 consecutive CTO and 100 non-CTO PCI patients were enrolled. SCI was detected by serum NSE measurements performed at baseline and 12 h after the interventions. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. Post-procedural NSE levels were found to be significantly higher in the CTO PCI group and NSE positivity was more prevalent in the CTO PCI group (56 (56%) vs. 31 (31%), p < 0.001), but PCI of CTOs did not independently increase risk of SCI (OR: 2.39 (0.85-6.73), p: 0.10). Patients who developed SCI after PCI had the characteristics of tough PCI interventions. In the multivariate analysis, two parameters were found to be independently associated with SCI development, namely more contrast volume (OR: 1.014 (1.005-1.023), p: 0.003) and longer procedural time (OR: 1.030 (1.010-1.051), p: 0.003). It has been firstly demonstrated in the literature that CTO PCIs, by its nature, have increased rates of SCI when compared to non-CTO PCIs but presence of a CTO was not an independent predictor of SCI. Mainly, procedural characteristics of the PCIs, especially longer procedural times and more contrast consumption, observed more in CTO PCIs, have been found to be independently associated with elevations of plasma NSE levels.
['Arslan|Uğur|U|http://orcid.org/0000-0001-8572-3571', 'Yenerçağ|Mustafa|M|', 'Erdoğan|Güney|G|', 'Görgün|Selim|S|']
D000368:Aged D058070:Asymptomatic Diseases D015415:Biomarkers D016022:Case-Control Studies D002544:Cerebral Infarction D002908:Chronic Disease D003324:Coronary Artery Disease D054059:Coronary Occlusion D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D062645:Percutaneous Coronary Intervention D010751:Phosphopyruvate Hydratase D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
Silent cerebral infarction Coronary Total occlusion Percutaneous intervention