Pan-immune-inflammation value as a novel predictor of new symptomatic infarction following carotid stenting in patients with symptomatic carotid stenosis.

This study examined the relationship between pre-procedural inflammatory indices and the occurrence of new symptomatic infarction (NSI) following carotid artery stenting (CAS) in patients with symptomatic carotid stenosis. We conducted a retrospective analysis of patients who underwent CAS from January 2015 to August 2024. Inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV), were calculated from pre-procedural venous blood samples. The primary outcome measured was NSI occurring within 30 days post-procedure. Among the 372 enrolled patients, NSI occurred in 14 patients (3.8%). The time interval between the index neurologic event and the procedure was significantly shorter in the NSI (+) group compared to the NSI (-) group (2.9 ± 1.7 days vs. 6.6 ± 6.1 days, P = 0.001). Among the inflammatory indices, PIV showed the highest predictive performance for NSI (area under the curve, [AUC]: 0.891, 95% CI: 0.829-0.943, P < 0.001) with an optimal cutoff of 403.2. Multivariate logistic analysis identified a short time interval (< 7 days; odds ratio [OR] 2.72, 95% confidence intervals [CI] 1.32-4.14; P = 0.002) and elevated PIV (≥ 403.2) (OR 1.42, 95% CI 1.10-1.92; P = 0.014) as independent predictors of NSI. PIV is a strong independent predictor of NSI after CAS in patients with symptomatic carotid stenosis. These findings suggest that PIV may serve as a valuable biomarker for risk stratification and clinical decision-making regarding the timing of CAS.