Silent cerebral infarction after percutaneous coronary intervention of chronic total occlusions (CTO) and non-CTOs
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ORIGINAL PAPER
Silent cerebral infarction after percutaneous coronary intervention of chronic total occlusions (CTO) and non‑CTOs Uğur Arslan1 · Mustafa Yenerçağ1 · Güney Erdoğan1 · Selim Görgün2 Received: 15 June 2020 / Accepted: 13 July 2020 © Springer Nature B.V. 2020
Abstract 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 12 ng/mL. The clinical characteristics of all patients were noted including age, sex, presence of diabetes mellitus, hypertension, heart failure (left ventricular ejection fraction 70% stenosis in one of the major coronary arteries confirmed with non-invasive tests. 6F guiding catheter with floppy wires were used in most of these patients, but in case of difficult lesions for PCI, 7F guiding catheters were used. Bifurcation lesions needing two-stent (non-provisional) strategy, severely calcific lesions and severely tortuous (> 90° angulation) proximal segment before the lesions were classified as difficult coronary lesions for non-CTO PCIs. Besides in patients with PCI procedural time > 60 min, the lesions were considered to be difficult. In these patients, other specialized wires, microcatheters and mother-in-child catheters were used where needed. Direct stenting was the preferred method, but in patients with stent uncrossable lesions, predilatation with balloons was done. Post-dilatation was also performed in selected cases. The procedural time, fluoroscopy time, and the consumed contrast volume were all noted. Procedural time was defined as the time between sheath insertion to extraction of the last catheter. Technical success for both groups was defined as successful revascularization with achievement of
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