Long-Term Stroke Risk in Patients With New Ischemic Brain Lesions on MRI After Carotid Revascularization
Simone J A Donners1, Marjolijn L Rots2, Raechel J Toorop1
1Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands (S.J.A.D., R.J.T., G.J.d.B.).
Background:
Carotid artery revascularization can result in new ischemic brain lesions on diffusion-weighted magnetic resonance imaging. This study aimed to investigate the relationship between periprocedural ischemic diffusion-weighted imaging (DWI) lesions after carotid artery revascularization and recurrent long-term cerebrovascular events.
Methods:
A secondary observational prospective cohort analysis of existing clinical trial data was performed on 162 patients with symptomatic carotid stenosis that were previously randomized to carotid artery stenting or carotid endarterectomy in the ICSS (International Carotid Stenting Study) and included in the magnetic resonance imaging substudy. Magnetic resonance imagings were performed 1 to 7 days before and 1 to 3 days after treatment. The primary composite clinical outcome was the time to any stroke or transient ischemic attack during follow-up. Patients with new diffusion-weighted imaging (DWI) lesions on posttreatment magnetic resonance imaging scan (DWI+) were compared with patients without new lesions (DWI-).
Results:
The median time of follow-up was 8.6 years (interquartile range, 5.0-12.5). Kaplan-Meier cumulative incidence for the primary outcome after 12.5-year follow-up was 35.3% (SE, 8.9%) in DWI+ patients and 31.1% (SE, 5.6%) in DWI- patients. Uni- and multivariable regression analyses did not show significant differences (hazard ratio, 1.50 [95% CI, 0.76-2.94] and hazard ratio, 1.30 [95% CI, 0.10-1.02], respectively). Higher event rate of the primary outcome in DWI+ patients in the overall cohort was mainly caused by events in the carotid artery stenting group.
Conclusions:
Based on our outcome analysis within the ICSS magnetic resonance imaging substudy, DWI lesions following carotid revascularization did not seem to have a relationship with long-term stroke risk.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: ISRCTN 25337470.
Insights
New brain lesions after carotid revascularization, detected by diffusion-weighted imaging (DWI), did not correlate with long-term stroke risk in a long-term study of patients undergoing carotid artery stenting or endarterectomy.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Carotid artery revascularization procedures can lead to new ischemic brain lesions.
- Diffusion-weighted imaging (DWI) is used to detect these lesions.
Purpose of the Study:
- To investigate the association between periprocedural DWI lesions and long-term cerebrovascular events after carotid revascularization.
- To compare outcomes in patients with and without new DWI lesions post-procedure.
Main Methods:
- Analysis of 162 patients from the International Carotid Stenting Study (ICSS) randomized trial.
- MRI scans were performed before and after carotid artery stenting or endarterectomy.
- Patients were categorized into DWI+ (new lesions) and DWI- (no new lesions) groups.
Main Results:
- Median follow-up was 8.6 years.
- No significant difference in the primary outcome (stroke or TIA) between DWI+ and DWI- groups (12.5-year cumulative incidence: 35.3% vs. 31.1%).
- Higher event rates in DWI+ patients were primarily observed in the carotid artery stenting subgroup.
Conclusions:
- DWI lesions detected after carotid revascularization do not appear to be associated with an increased long-term risk of stroke.
- Findings suggest that DWI lesion status may not be a reliable predictor of long-term cerebrovascular events in this patient cohort.
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