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Cerebral ischemia after carotid intervention
H Zwenneke Flach1, Mohamed Ouhlous, Johanna M Hendriks
1Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. h.flach@erasmusmc.nl
Summary
Diffusion-weighted MRI detected more ischemic lesions after carotid stenting than endarterectomy, though most lesions were asymptomatic. This highlights potential risks associated with carotid stenting procedures.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Cerebrovascular disease poses a significant health risk.
- Carotid interventions like stenting (CAS) and endarterectomy (CEA) are crucial for stroke prevention.
- Assessing the incidence of cerebral ischemic lesions post-intervention is vital for patient safety.
Purpose of the Study:
- To determine the incidence of symptomatic and asymptomatic cerebral ischemic lesions after carotid interventions.
- To compare lesion incidence between CAS and CEA using diffusion-weighted magnetic resonance imaging (DW-MRI).
Main Methods:
- A prospective study involving 44 patients with carotid artery disease undergoing CAS or CEA.
- DW-MRI scans were performed before and after the intervention.
- New cerebral ischemic lesions were identified and quantified by experienced radiologists.
Main Results:
- Carotid stenting (CAS) showed a higher incidence of new ischemic lesions (43%) compared to carotid endarterectomy (CEA) (9%).
- While 6.8% of patients suffered strokes, the majority of DW-MRI detected lesions were asymptomatic.
- Asymptomatic patients had significantly fewer lesions and a smaller lesion load than symptomatic patients.
Conclusions:
- DW-MRI reveals a higher frequency of ischemic lesions after CAS compared to CEA.
- The majority of these DW-MRI detected lesions do not manifest as clinical neurological deficits.
- Further research may be warranted to understand the long-term implications of these subclinical lesions.