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Post-interventional microembolism: cortical border zone is a preferential site for ischemia

Kwang-Yeol Park1, Pil-Wook Chung, Yong Bum Kim

  • 1Department of Neurology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, South Korea.

Cerebrovascular Diseases (Basel, Switzerland)
|September 7, 2011
PubMed
Abstract

Insights

Silent embolisms after neurointerventional procedures commonly affect the cerebral cortical border zone and cerebellum. Microembolisms rarely impact deep perforating artery territories, according to diffusion-weighted MRI findings.

Area of Science:

  • Neuroimaging and Interventional Neurology
  • Cerebrovascular Diseases
  • Radiology

Background:

  • Silent embolism is a known complication of neurointerventional procedures, occurring in 10-40% of patients.
  • Previous studies using diffusion-weighted MRI (DWI) have identified these embolisms, but their specific lesion patterns remain under-investigated.

Purpose of the Study:

  • To investigate the lesion patterns of silent embolisms following cerebral angioplasty and stent procedures.
  • To classify and analyze the distribution of new DWI lesions in non-treated arterial territories.

Main Methods:

  • Diffusion-weighted MRI (DWI) was performed within 7 days before and 48 hours after neurointerventional procedures.
  • New DWI lesions were analyzed and classified based on arterial territories: supratentorial (cortical and subcortical) and infratentorial (brainstem and cerebellar).
  • Cortical lesions were further categorized into cortical border zone and cortical proper; subcortical lesions into deep perforator and internal border zone.

Main Results:

  • Out of 72 patients, 37 had 223 new DWI lesions in non-treated territories.
  • The majority of lesions were cortical (154), predominantly in the cortical border zone (88/154).
  • Infratentorial lesions were mainly in the cerebellar hemisphere (45/48), while deep perforator territory lesions were rare (4/223).

Conclusions:

  • Interventional angiography-related microembolisms predominantly localize to the cerebral cortical border zone and cerebellar hemisphere.
  • Microembolisms affecting the deep perforating artery territory are infrequent.
  • DWI is crucial for characterizing the patterns and locations of silent embolisms post-neurointervention.

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