Silent ischemia after neuroprotected percutaneous carotid stenting: a diffusion-weighted MRI study
P Piñero1, A González, A Mayol
1Section of Neuroradiology, Hospitales Universitarios Virgen del Rocío, 41013 Seville, Spain.
AJNR. American Journal of Neuroradiology
|June 16, 2006
Summary
Diffusion-weighted MR imaging revealed new ischemic lesions in 17.3% of patients undergoing carotid artery stenting with cerebral protection devices. Transient ischemic attacks, not microembolic signals, were linked to these new lesions.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Severe internal carotid artery (ICA) stenosis poses a risk of stroke.
- Carotid artery stenting (CAS) is a treatment option for severe ICA stenosis.
- Cerebral protection devices aim to prevent embolization during CAS.
Purpose of the Study:
- To evaluate the effectiveness of cerebral protection devices during CAS.
- To assess the incidence of new ischemic lesions using diffusion-weighted MR imaging (DWI).
- To identify factors associated with new ischemic lesion formation post-CAS.
Main Methods:
- 162 CAS procedures using distal filters were analyzed.
- Diffusion-weighted MR imaging (DWI) was performed before and within 24 hours after CAS.
- Transcranial Doppler ultrasonography monitored microemboli in 58.6% of patients.
Main Results:
- 17.3% of patients developed new ischemic foci on DWI after CAS.
- New lesions were primarily in the ipsilateral middle cerebral artery (MCA) territory.
- Transient ischemic attack (TIA) occurrence was significantly related to new lesion appearance (P < .03).
- No significant relationship was found between microembolic signals (MES) and new lesions.
Conclusions:
- Cerebral protection devices are associated with new ischemic lesions in 17.3% of CAS procedures.
- TIA is a significant predictor of new ischemic lesions, unlike MES.
- Further research is needed to develop safer CAS techniques and devices to reduce lesion incidence.
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