1
|
Hu J, Hu N, Hu T, Zhang J, Han D, Wang H. Associations between preprocedural carotid artery perivascular fat density and early in-stent restenosis after carotid artery stenting. Heliyon 2023; 9:e16220. [PMID: 37346364 PMCID: PMC10279783 DOI: 10.1016/j.heliyon.2023.e16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives This study investigated the association between perivascular fat density (PFD) via preoperative computed tomographic angiography (CTA) and early in-stent restenosis (ISR) after carotid artery stenting (CAS). Methods We retrospectively evaluated 248 consecutive patients who had undergone initial CAS and received a preoperative cervical CTA examination between January 2019 and October 2020. The patients were categorized into two according to whether they sustained ISR during the 2 years postoperative follow-up period. Correlations between PFD and ISR were assessed, and multivariate regression for evaluating predictors of ISR was conducted. Receiver operating characteristic (ROC) curves were used to determine the cutoff value for the PFD. Results A total of 181 eligible patients (mean age 61.25 ± 10.35 years, 57 male) were enrolled. The ISR group had a higher proportion of closed-cell stents (48.8% versus 27.5%; p = 0.009) and a greater degree of residual stenosis (28[20,33] % versus 20[14.75,30] %; p < 0.001) than the non-ISR group. The ISR group had a higher mean HU value of PFD than the non-ISR group on the operated side (-42.26 ± 6.81 versus -59.66 ± 10.75; p < 0.001). The degree of residual stenosis (OR 1.146, 95%CI 1.071-1.226, p < 0.001) and PFD on the operated side (OR1.353, 95%CI 1.215-1.506, p < 0.001) were significantly associated with the ISR. Conclusions The occurrence of the early ISR after CAS is associated with a higher PFD on the operated side. The results indicate that PFD is a promising marker to predict the ISR after CAS.
Collapse
Affiliation(s)
- Jun Hu
- Faculty of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Na Hu
- Department of Radiology, Chengde Central Hospital, Chengde, China
| | - Tiemin Hu
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Jiwei Zhang
- Department of Neurosurgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Dong Han
- Department of Radiology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Hong Wang
- Faculty of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang, China
| |
Collapse
|
2
|
Niculescu R, Russu E, Arbănași EM, Kaller R, Arbănași EM, Melinte RM, Coșarcă CM, Cocuz IG, Sabău AH, Tinca AC, Stoian A, Vunvulea V, Mureșan AV, Cotoi OS. Carotid Plaque Features and Inflammatory Biomarkers as Predictors of Restenosis and Mortality Following Carotid Endarterectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113934. [PMID: 36360814 PMCID: PMC9654888 DOI: 10.3390/ijerph192113934] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is the first-line surgical intervention for cases of severe carotid stenoses. Unfortunately, the restenosis rate is high after CEA. This study aims to demonstrate the predictive role of carotid plaque features and inflammatory biomarkers (monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in carotid restenosis and mortality at 12 months following CEA. METHODS The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a minimum of 70% carotid stenosis and surgical indications for CEA admitted to the Vascular Surgery Clinic, Emergency County Hospital of Targu Mures, Romania between 2018 and 2021. RESULTS According to our results, the high pre-operative values of inflammatory biomarkers-MLR (OR: 10.37 and OR: 6.11; p < 0.001), NLR (OR: 34.22 and OR: 37.62; p < 0.001), PLR (OR: 12.02 and OR: 16.06; p < 0.001), SII (OR: 18.11 and OR: 31.70; p < 0.001), SIRI (OR: 16.64 and OR: 9.89; p < 0.001), and AISI (OR: 16.80 and OR: 8.24; p < 0.001)-are strong independent factors predicting the risk of 12-month restenosis and mortality following CEA. Moreover, unstable plaque (OR: 2.83, p < 0.001 and OR: 2.40, p = 0.04) and MI (OR: 3.16, p < 0.001 and OR: 2.83, p = 0.005) were independent predictors of all outcomes. Furthermore, AH (OR: 2.30; p = 0.006), AF (OR: 1.74; p = 0.02), tobacco (OR: 2.25; p < 0.001), obesity (OR: 1.90; p = 0.02), and thrombotic plaques (OR: 2.77; p < 0.001) were all independent predictors of restenosis, but not for mortality in all patients. In contrast, antiplatelet (OR: 0.46; p = 0.004), statin (OR: 0.59; p = 0.04), and ezetimibe (OR:0.45; p = 0.03) therapy were protective factors against restenosis, but not for mortality. CONCLUSIONS Our data revealed that higher preoperative inflammatory biomarker values highly predict 12-month restenosis and mortality following CEA. Furthermore, age above 70, unstable plaque, cardiovascular disease, and dyslipidemia were risk factors for all outcomes. Additionally, AH, AF, smoking, and obesity were all independent predictors of restenosis but not of mortality in all patients. Antiplatelet and statin medication, on the other hand, were protective against restenosis but not against mortality.
Collapse
Affiliation(s)
- Raluca Niculescu
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139, Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Réka Kaller
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Răzvan Marian Melinte
- Department of Orthopedics, Regina Maria Health Network, 540098 Targu Mures, Romania
- Department of Orthopedics, Humanitas MedLife Hospital, 400664 Cluj Napoca, Romania
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Iuliu Gabriel Cocuz
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Adrian Horațiu Sabău
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Andreea Cătălina Tinca
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Vlad Vunvulea
- Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139, Targu Mures, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| |
Collapse
|
3
|
Zhang R, Tao Z, Gong J, Ji Z, Yang M, Ma G, Li Y. Albumin to Globulin Ratio was associated with in-stent restenosis and revascularization events after percutaneous coronary intervention. Clin Transl Sci 2022; 15:1187-1195. [PMID: 35195938 PMCID: PMC9099125 DOI: 10.1111/cts.13236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 01/09/2023] Open
Abstract
In-stent restenosis is a common complication after percutaneous coronary intervention (PCI) for coronary heart disease requiring revascularization. We performed a retrospective analysis to assess the value of inflammatory biomarker Albumin to Globulin Ratio (AGR) in clinical prognosis of percutaneous coronary intervention (PCI). In total, 992 coronary heart disease (CHD) patients who underwent the first drug-eluting stent implantation and reexamination angiography in our hospital were enrolled in this study. Albumin to Globulin Ratio was measured. At mean follow-up of 11.2 ± 4 months, the in-stent restenosis (ISR) and revascularization events (including target lesion revascularization, target vessel revascularization, and revascularization of de novo lesions) occurred in 127 and 284 patients respectively. Compared with the non-ISR or non-event group, AGR was significantly lower in the ISR group and events group. Beyond that, albumin was significantly lower, while urea nitrogen, glucose and gensini score, as well as the proportions of a history of diabetes and peripheral vascular diseases, were significantly higher in the ISR group and events group. Age, heart rate, white blood cell, neutrophils, lymphocyte, monocyte and incidence of ischemic stroke were significantly higher in the events group. Multivariate cox regression analysis showed that AGR was independently associated with ISR (P = 0.032) and events (P = 0.024). Besides, Kaplan-Meier analysis indicated that the higher quartile of AGR had a lower rate of ISR (P = 0.038) and events (p ≤ 0.001). Finally, the receiver operating characteristic (ROC) curve for AGR in diagnosing ISR and events indicated that the area under the curve (AUC) were 0.56 and 0.57 respectively. Therefore, AGR is one of the most important factors that independently associate with the ISR and revascularization events after PCI.
Collapse
Affiliation(s)
- Rui Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zaixiao Tao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jing Gong
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenjun Ji
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Mingming Yang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yongjun Li
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|
4
|
Pereira-Neves A, Saramago S, Duarte-Gamas L, Domingues-Monteiro D, Fragão-Marques M, Marques-Vieira M, Andrade JP, Pais S, Rocha-Neves J. MEAN PLATELET VOLUME PREDICTS RESTENOSIS AFTER CAROTID ENDARTERECTOMY. Ann Vasc Surg 2021; 81:216-224. [PMID: 34748948 DOI: 10.1016/j.avsg.2021.08.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Carotid restenosis following carotid endarterectomy (CEA) has a cumulative risk at 5-years up to 32%, which may impact the well-being of patients following CEA. Haematological parameters in the standard complete blood cell count (CBC) are emerging as potential biomarkers, but their application in CEA is scarce. The primary aim of this study was to investigate haematological markers for restenosis following CEA. The secondary aim was to characterize clinical risk factors for restenosis. METHODS From January 2012 to January 2019, 151 patients who underwent CEA under regional anaesthesia due to carotid stenosis were selected from a prospectively maintained cohort database. Patients were included if a preoperative CBC was available in the two weeks preceding CEA. Multivariable analysis was performed alongside propensity score matching (PSM) analysis, using the preoperative CEA parameters, to reduce confounding factors between categories. RESULTS The study group comprised 28 patients who developed carotid restenosis. The remaining 123 patients without restenosis composed the control group. Mean age of the patients did not differ significantly between groups (70.25±8.05 vs. 70.32 ± 9.61 YO, p=0.973), neither did gender (male gender 89.3% vs. 78.9%, p=0.206). Regarding haematological parameters, only MPV remained statistically significant within multivariable analysis (1.855, aOR [1.174-2.931], p=0.008), a result supported by PSM analysis (2.072, aOR [1.036-4.147], p=0.042). CONCLUSION MPV was able to predict restenosis two years after CEA. Thus, MPV can be incorporated into score calculations to identify patients at greater risk of restenosis, who could benefit from specific monitoring during follow-up. While results are promising, more research is necessary to corroborate them.
Collapse
Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Sean Saramago
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal.
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Diogo Domingues-Monteiro
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Mário Marques-Vieira
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Hospital de Braga, EPE, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - José P Andrade
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Sandra Pais
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; Comprehensive Health Research Centre (CHRC), Lisboa, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; Centro Internacional sobre o Envelhecimento, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; ABC-RI, Algarve Biomedical Center Research Institute, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal.
| | - João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| |
Collapse
|
5
|
Çakmak EÖ, Öcal L, Erdoğan E, Cerşit S, Efe SÇ, Karagöz A, Yılmaz F, Fidan S, Alizade E, Zehir R, Kırma C. Prognostic Value of 3 Nutritional Screening Tools to Predict 30-Day Outcome in Patients Undergoing Carotid Artery Stenting. Angiology 2021; 73:225-233. [PMID: 34463144 DOI: 10.1177/00033197211040365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effect of malnutrition on outcomes after carotid artery stenting (CAS) is not well known. This study reports the relationship between malnutrition and post-procedure 30-day major adverse events (MAEs). A total of 978 patients hospitalized for CAS were enrolled in the study. Controlling nutritional status (CONUT) score, the nutritional risk index (NRI), and the prognostic nutritional index (PNI) were calculated. MAEs (myocardial infarction, stroke/transient ischemic attack and mortality) were compared. According to the CONUT score, NRI, and PNI, 9.4%, 41%, and 11.4% patients were moderately or severely malnourished, respectively; 74.8% were at least mildly malnourished by at least 1 score. Forty-seven patients (4.8%) had a post-procedure 30-day MAE. Continuous classifications of the indexes were independently associated with higher MAE. CONUT showed the highest predictive ability, whereas NRI had the lowest (C-index: CONUT, 0.701; NRI, 0.681; PNI, 0.688). According to categorical classification of indexes, only CONUT and PNI showed predictive ability for MAE. Malnutrition assessment could identify patients with CAS at elevated risk for MAE. CONUT, NRI, and PNI continuous scores were independent prognostic factors for the post-procedure 30-day MAE. According to our study, CONUT showed the highest predictive ability.
Collapse
Affiliation(s)
- Ender Ö Çakmak
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Öcal
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Emrah Erdoğan
- Department of Cardiology, 53000Van Yüzüncü Yıl University, Van, Turkey
| | - Sinan Cerşit
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Çağan Efe
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Fatih Yılmaz
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Serdar Fidan
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Elnur Alizade
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Regayip Zehir
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| | - Cevat Kırma
- Department of Cardiology, 111350University of Medical Sciences, Kartal Kosuyolu High Specialty Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
Dettori P, Paliogiannis P, Pascale RM, Zinellu A, Mangoni AA, Pintus G. Blood Cell Count Indexes of Systemic Inflammation in Carotid Artery Disease: Current Evidence and Future Perspectives. Curr Pharm Des 2021; 27:2170-2179. [PMID: 33355049 DOI: 10.2174/1381612826666201222155630] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 11/22/2022]
Abstract
Carotid artery disease is commonly encountered in clinical practice and accounts for approximately 30% of ischemic strokes in the general population. Numerous biomarkers have been investigated as predictors of the onset and progression of carotid disease, the occurrence of cerebrovascular complications, and overall prognosis. Among them, blood cell count (BCC) indexes of systemic inflammation might be particularly useful, from a pathophysiological and clinical point of view, given the inflammatory nature of the atherosclerotic process. The aim of this review is to discuss the available evidence regarding the role of common BCC indexes, such as the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW), in the diagnosis and risk stratification of carotid artery disease, and their potential clinical applications.
Collapse
Affiliation(s)
| | - Panagiotis Paliogiannis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Rosa M Pascale
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gianfranco Pintus
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| |
Collapse
|
7
|
Haidegger M, Kneihsl M, Niederkorn K, Deutschmann H, Mangge H, Vetta C, Augustin M, Wünsch G, Fandler-Höfler S, Horner S, Enzinger C, Gattringer T. Blood biomarkers of progressive atherosclerosis and restenosis after stenting of symptomatic intracranial artery stenosis. Sci Rep 2021; 11:15599. [PMID: 34341413 PMCID: PMC8329296 DOI: 10.1038/s41598-021-95135-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/12/2021] [Indexed: 01/14/2023] Open
Abstract
In-stent restenosis (ISR) represents a major complication after stenting of intracranial artery stenosis (ICAS). Biomarkers derived from routine blood sampling including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) have been associated with progressive atherosclerosis. We investigated the role of CRP, NLR, PLR and MPV on the development of intracranial ISR and recurrent stroke risk. We retrospectively included all patients who had undergone stenting of symptomatic ICAS at our university hospital between 2005 and 2016. ISR (≥ 50% stenosis) was diagnosed by regular Duplex sonography follow-up studies and confirmed by digital subtraction angiography or computed tomography angiography (mean follow-up duration: 5 years). Laboratory parameters were documented before stenting, at the time of restenosis and at last clinical follow-up. Of 115 patients (mean age: 73 ± 13 years; female: 34%), 38 (33%) developed ISR. The assessed laboratory parameters did not differ between patients with ISR and those without (p > 0.1). While ISR was associated with the occurrence of recurrent ischemic stroke (p = 0.003), CRP, NLR, PLR and MPV were not predictive of such events (p > 0.1). Investigated blood biomarkers of progressive atherosclerosis were not predictive for the occurrence of ISR or recurrent ischemic stroke after ICAS stenting during a 5-year follow-up.
Collapse
Affiliation(s)
- Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
| | - Kurt Niederkorn
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Christian Vetta
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Michael Augustin
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Gerit Wünsch
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Susanna Horner
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| |
Collapse
|
8
|
Keskin M, Öcal L, Cerşit S, Yılmaz C, Küp A, Çelik M, Doğan S, Koyuncu A, Kaya A, Turkmen MM. The Predictive Role of a Novel Risk Index in Patients Undergoing Carotid Artery Stenting: Systemic Immune-Inflammation Index. J Stroke Cerebrovasc Dis 2021; 30:105955. [PMID: 34242858 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/28/2021] [Accepted: 06/13/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Inflammatory mechanisms play an important role in both atherosclerosis and stroke. There are several inflammatory peripheral blood count markers associated with carotid artery stenosis degree, symptomatic carotid artery lesions and carotid artery stent restenosis that reported in previous studies. However, the prognostic role of the blood cell counts and their ratios in predicting in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS) has not been comprehensively investigated. Systemic immune-inflammation index (SII) proved its' efficiency in patients with solid tumors and its' role was rarely examined in cardiovascular disorders and stroke. The current study evaluated the effect of this novel risk index on in-hospital and long-term outcomes in a large patient population who underwent CAS. METHOD A total of 732 patients with carotid artery stenosis who underwent CAS were enrolled to the study. SII was calculated using the following formula: neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood (per mm3) and the patients were stratified accordingly: T1, T2 and T3. In-hospital and 5-year outcomes were compared between the tertiles of SII. RESULTS During the hospitalization, major stroke, ipsilateral stoke, myocardial infarction, death and major adverse cardiovascular events (MACE) rates were significantly higher in high SII level (T3) compared to SII levels (T1 and 2). In long-term outcomes, ipsilateral stroke, major stroke, transient ischemic attack, death, and MACE were significantly higher in the patients with higher SII level (T3). The 5-year Kaplan-Meier overall survival for T1, T2, and T3 were 97.5%, 96.7% and 86.0% respectively. In-hospital and 5-year regression analyses demonstrated that high SII was independently associated with MACE and mortality. CONCLUSION SII was independently associated with in-hospital and long-term clinical outcomes in patients undergoing CAS. Immune and inflammation status, as assessed easily and quickly using SII, has a good discriminative value in these patients.
Collapse
Affiliation(s)
- Muhammed Keskin
- Cardiology, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey.
| | - Lütfi Öcal
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Sinan Cerşit
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Cemalettin Yılmaz
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Küp
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Çelik
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Selami Doğan
- Cardiology, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey
| | | | - Adnan Kaya
- Cardiology, Duzce University, Duzce, Turkey
| | - Mehmet Muhsin Turkmen
- Cardiology, Health Sciences University, Kartal Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Huang LY, Sun FR, Yin JJ, Ma YH, Li HQ, Zhong XL, Yu JT, Song JH, Tan L. Associations of the neutrophil to lymphocyte ratio with intracranial artery stenosis and ischemic stroke. BMC Neurol 2021; 21:56. [PMID: 33546646 PMCID: PMC7863476 DOI: 10.1186/s12883-021-02073-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) has emerged as an inflammatory marker. However, the associations of NLR with intracranial artery stenosis (ICAS) and ischemic stroke remain unclear. This study aimed to examine the associations of NLR with ICAS and ischemic stroke among a large and high-risk population. Methods Participants with records of clinical characteristics were prospectively recruited from the Neurology Department and Health & Physical Examination Center of Qingdao Municipal Hospital. Logistic regression analysis was used to examine the associations of NLR with ICAS and ischemic stroke. Moreover, we also conducted parametric mediation analysis to estimate the effect of NLR on the risk of ischemic stroke mediated through ICAS. Results A total of 2989 participants were enrolled in this study. After adjusting for covariates, NLR (OR = 1.125, 95%CI 1.070–1.183) and ICAS (OR = 1.638, 95%CI 1.364–1.967) were significantly associated with ischemic stroke. Compared with the first quartile NLR, the second, third and fourth quartiles NLR were independent risk predictors for ischemic stroke (P for trend < 0.001); the third and fourth quartiles were independent predictors for ICAS (P for trend < 0.001). The mediation analysis showed that ICAS partially mediated the association between NLR and ischemic stroke, accounting for 14.4% of the total effect (P < 0.001). Conclusions NLR was significantly associated with ICAS and ischemic stroke. Besides, ICAS partially mediated the association between NLR and ischemic stroke.
Collapse
Affiliation(s)
- Liang-Yu Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Fu-Rong Sun
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Jian-Jun Yin
- Department of Neurology, Qingdao Hiser Hospital, Qingdao University, Qingdao, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xiao-Ling Zhong
- Department of Neurology, Qingdao Central Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12th Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Jing-Hui Song
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China.
| |
Collapse
|
10
|
Chronic Systemic Inflammation Measured by Bioimpedance Technology Before and After Sleeve Gastrectomy: A Feasibility Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1339:169-177. [DOI: 10.1007/978-3-030-78787-5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Jackson SM, Perry LA, Borg C, Ramson DM, Campbell R, Liu Z, Nguyen J, Douglas N, Kok J, Penny-Dimri J. Prognostic Significance of Preoperative Neutrophil-Lymphocyte Ratio in Vascular Surgery: Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2020; 54:697-706. [PMID: 32840176 DOI: 10.1177/1538574420951315] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery. METHODS We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively. RESULTS Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review. CONCLUSIONS NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.
Collapse
Affiliation(s)
- Sarah M Jackson
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Luke A Perry
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Carla Borg
- Department of Surgery, 22457Monash University, Clayton, Victoria, Australia
| | - Dhruvesh M Ramson
- Department of Surgery, 22457Monash University, Clayton, Victoria, Australia
| | - Ryan Campbell
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Zhengyang Liu
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Jacqueline Nguyen
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia.,Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Ned Douglas
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Juliana Kok
- Department of Anaesthesia, 90134Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jahan Penny-Dimri
- Department of Surgery, 22457Monash University, Clayton, Victoria, Australia
| |
Collapse
|
12
|
Öcal L, Küp A, Keskin M, Cerşit S, Çelik M, Eren H, Gürsoy MO, Öztürkeri B, Öztürk B, Turkmen MM. Prognostic significance of pre-procedural prognostic nutritional index in patients with carotid artery stenting. J Stroke Cerebrovasc Dis 2020; 29:104932. [PMID: 32689619 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Inflammation and malnutrition play a critical role in the outcomes of patients undergoing carotid artery stenting (CAS). Prognostic nutritional index (PNI) is commonly utilized to evaluate the peri-operative immune-nutritional status of patients undergoing colorectal cancer surgery and is independently associated with survival. We assessed the association between immune-nutritional status, indexed by PNI, and outcomes in CAS patients. METHODS A total of 615 patients hospitalized for CAS in a tertiary heart center were enrolled in the study. PNI was calculated using the following formula: 10× serum albumin value (g/dL) + 0.005 × total lymphocyte count in the peripheral blood (per mm3). In-hospital and 5-year outcomes (ipsilateral stroke, major stroke, transient ischemic attack, myocardial infarction, and mortality) were compared between the tertiles of PNI. RESULTS In-hospital outcomes were similar between the groups except the increased mortality in decreasing tertiles of PNI. During a mean follow-up duration of 51.1 months, the lower PNI tertile was related to unfavorable outcomes. After adjusting for multi-model Cox regression analysis, PNI persisted as an independent prognostic factor for mortality and major stroke. CONCLUSION PNI was independently associated with long-term mortality and major stroke in CAS patients. Malnutrition and inflammation, which can be assessed easily and quickly using PNI, have an important prognostic value in the patients undergoing CAS.
Collapse
Affiliation(s)
- Lütfi Öcal
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology, Health Sciences University, Istanbul, Turkey.
| | - Ayhan Küp
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology, Health Sciences University, Istanbul, Turkey.
| | - Muhammed Keskin
- Sultan Abdulhamid Han Training and Research Hospital, Cardiology, Health Sciences University, Istanbul, Turkey.
| | - Sinan Cerşit
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology, Health Sciences University, Istanbul, Turkey.
| | - Mehmet Çelik
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology, Health Sciences University, Istanbul, Turkey.
| | - Hayati Eren
- Cardiology, Elbistan State Hospital, Kahramanmaraş, Turkey.
| | - Mustafa Ozan Gürsoy
- Cardiology, Atatürk Training And Research Hospital, Katip Çelebi University, İzmir, Turkey.
| | - Burak Öztürkeri
- Ümraniye Training and Research Hospital, Cardiology, Health Sciences University, Istanbul, Turkey.
| | - Bayram Öztürk
- Cardiology, Sutcu Imam University, Kahramanmaraş, Turkey.
| | - Mehmet Muhsin Turkmen
- Kartal Koşuyolu Heart Training and Research Hospital, Cardiology, Health Sciences University, Istanbul, Turkey.
| |
Collapse
|
13
|
Texakalidis P, Tzoumas A, Giannopoulos S, Jonnalagadda AK, Jabbour P, Rangel-Castilla L, Machinis T, Rivet DJ, Reavey-Cantwell J. Risk Factors for Restenosis After Carotid Revascularization: A Meta-Analysis of Hazard Ratios. World Neurosurg 2019; 125:414-424. [PMID: 30822589 DOI: 10.1016/j.wneu.2019.02.065] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carotid artery restenosis after carotid endarterectomy (CEA) or carotid artery stenting (CAS) will occur in 3%-30% of cases. Restenosis can lead to more frequent clinical and imaging monitoring and the potential for reoperation. We sought to define the demographic, clinical, and radiographic characteristics that influence the restenosis risk after carotid revascularization. METHODS The present study was performed in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. A random effects model meta-analysis of hazard ratios (HRs) was conducted. RESULTS Eighteen studies with 17,106 patients were included. Diabetes (HR, 1.68; 95% confidence interval [CI], 1.00-2.83; I2, 76.7%), dyslipidemia (HR, 1.77; 95% CI, 1.08-2.91; I2, 22.5%), female gender (HR, 1.50; 95% CI, 1.14-1.98, I2, 0%), chronic kidney disease (HR, 4.15; 95% CI, 1.69-10.19; I2, 44.5%), hypertension (HR, 1.99; 95% CI, 1.07-3.72; I2, 68%), smoking (HR, 1.65; 95% CI, 1.15-2.37; I2, 54.3%), and pretreatment stenosis >70% (HR, 1.04; 95% CI, 1.0-1.08; I2, 0%) showed a statistically significant increase in restenosis risk after carotid revascularization. Subgroup analyses of CEA and CAS showed that female gender and smoking status were significantly associated with recurrent stenosis after CEA but not after CAS. In contrast, hypertension was associated with restenosis after CAS but not after CEA. Patch endarterectomy (HR, 0.33; 95% CI, 0.22-0.50; I2, 0%) and symptomatic status at presentation in the CAS group (HR, 0.61; 95% CI, 0.41-0.90; I2, 0%) were associated with a decreased risk of restenosis. Antiplatelet use and coronary artery disease were not associated with restenosis risk. CONCLUSIONS Diabetes, dyslipidemia, female gender, renal failure, hypertension, and smoking were associated with an increased risk of restenosis, and patch endarterectomy and symptomatic status at presentation were associated with a decreased risk of carotid restenosis. Both female gender and current smoking status were only associated with recurrent stenosis after CEA, and hypertension was only associated with restenosis after CAS.
Collapse
Affiliation(s)
- Pavlos Texakalidis
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Andreas Tzoumas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Anil K Jonnalagadda
- Department of Cardiology, Medstar Washington Hospital Center, Washington District of Columbia, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Theofilos Machinis
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dennis J Rivet
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John Reavey-Cantwell
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
14
|
Dai Z, Li R, Ma M, Xu G. Reply to Letter by Dr Demirtas et al "Cerebrovascular Events in Stenting for Carotid Artery Stenosis". Angiology 2018; 70:188. [PMID: 30380908 DOI: 10.1177/0003319718808920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zhengze Dai
- 1 Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.,2 Department of Neurology, Nanjing Pukou Hospital, Nanjing, Jiangsu, China
| | - Rongrong Li
- 3 Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Minmin Ma
- 1 Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.,3 Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Gelin Xu
- 1 Department of Neurology, Jinling Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.,3 Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| |
Collapse
|
15
|
Demirtas K, Yayla Ç, Yayla KG, Ertem AG, Açar B, Unal S, Karanfil M, Akboga MK. Cerebrovascular Events in Stenting for Carotid Artery Stenosis. Angiology 2018; 70:187. [PMID: 30231619 DOI: 10.1177/0003319718801086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Koray Demirtas
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Çağri Yayla
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- 2 Diskapi Yildirim Beyazit Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Ahmet Goktug Ertem
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Burak Açar
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Sefa Unal
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mustafa Karanfil
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| | - Mehmet Kadri Akboga
- 1 Türkiye Yüksek Ihtisas Training and Research Hospital, Cardiology Clinic, Ankara, Turkey
| |
Collapse
|