Risk factors for periprocedural complications in carotid artery stenting without filter protection: A serial
Hilmar Krapf1, Thomas Nägele, Andreas Kastrup
1Dept. of Neuroradiology, University of Tuebingen, Tuebingen, Germany.
Introduction:
In high-grade stenosis, carotid artery stenting (CAS) may be chosen as an alternative to carotid surgery. Ischemic periprocedural complications may be documented best with diffusion-weighted MRI (DWMRI). In this prospective study serial DW-MRI and color-coded duplex sonography (CCDS) were used to identify carotid stenosis, which is associated with an increased risk of ischemic events due to CAS.
Methods:
High resolution DW-MRI were performed in 74 out of 77 patients before and after CAS. All MRI scans were analyzed in a blinded manner. With CCDS each carotid stenosis was evaluated according to the grade, length, echo properties and plaque surface.
Results:
In 42 out of 74 patients (56.8 %) a total of 188 new procedure- related DWI-lesions could be detected, while in 32 patients MRI-controls remained normal. Of the lesions 79.25 % had a size < 1 cm. In one major and two minor strokes due to CAS (total complication rate 3.9 %) corresponding territorial infarcts could be demonstrated. A highly significant correlation was found between the length of the stenosis and the incidence of new DWI-lesions (p = 0.0141). In contrast, neither the grade of ICA stenosis nor the sonographic plaque morphology or plaque surface correlated with the number of DWI-lesion in postinterventional scans.
Conclusions:
The length-and not the degree-of an ICA stenosis seems to be the most decisive sonographic factor for estimating the periprocedural risk of embolism. DWI-lesions are much more frequent than clinical complications and may represent an important surrogate marker for improving the techniques of carotid artery stenting, especially comparing the benefit of different mechanical protection devices.
Insights
Carotid artery stenting (CAS) can cause new diffusion-weighted MRI lesions, especially with longer carotid stenosis. Lesion length, not degree, predicts embolism risk, guiding technique improvement.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Carotid artery stenting (CAS) is an alternative to surgery for high-grade stenosis.
- Diffusion-weighted MRI (DWMRI) best documents periprocedural ischemic complications.
- Color-coded duplex sonography (CCDS) and DWMRI identify stenosis and associated risks.
Purpose of the Study:
- To prospectively evaluate the relationship between carotid stenosis characteristics and periprocedural ischemic events detected by DWMRI after CAS.
- To assess the utility of DWMRI in identifying subclinical embolic events during CAS.
Main Methods:
- Serial high-resolution DWMRI scans were performed before and after CAS in 74 patients.
- All MRI scans were analyzed in a blinded manner.
- CCDS evaluated stenosis grade, length, plaque echogenicity, and surface characteristics.
Main Results:
- New DWMRI lesions were detected in 56.8% of patients (188 lesions total).
- A significant correlation exists between stenosis length and new DWMRI lesions (p=0.0141).
- Stenosis grade and plaque morphology did not correlate with DWMRI lesion incidence.
Conclusions:
- Stenosis length, not degree, is a key sonographic factor for estimating periprocedural embolism risk.
- DWMRI lesions are more frequent than clinical events and serve as a surrogate marker for improving CAS techniques and device comparison.
