American Journal of Neuroradiology 27:1338-1345, June-July 2006
© 2006 American Society of Neuroradiology
INTERVENTIONAL
Silent Ischemia after Neuroprotected Percutaneous Carotid Stenting: A Diffusion-Weighted MRI Study
a From the Sections of Neuroradiology, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
b Interventional Neuroradiology, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
c Department of Radiology; the Department of Neurology, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
d Department of Neurophysiology, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
e Research Unit, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain
Address correspondence to Pilar Piñero, MD, Gerardo Diego 9, P.1, 2D, 41013, Seville. Spain
BACKGROUND AND PURPOSE: To assess by diffusion-weighted MR imaging (DWI) the efficacy of cerebral protection devices in avoiding embolization and new ischemic lesions in patients with severe internal carotid artery (ICA) stenosis undergoing carotid artery stent placement (CAS).
METHODS: One hundred sixty-two CASs in the extracranial ICA were performed with the use of distal filters. Mean age of the patients was 68.5 years (range, 33–86) and 122 patients (75.3%) were symptomatic. MR imaging was performed in all patients during the 3-day period before CAS, and DWI was obtained within 24 hours after the procedure. Ninety-five patients (58.6%) were monitored by transcranial Doppler ultrasonography for microemboli detection in the territory of the middle cerebral artery (MCA), ipsilateral to the vessel being treated.
RESULTS: Twenty-eight patients (17.3%) showed 58 new ischemic foci in DWI, and 13 patients (46.4%) had multiple foci. Location of new lesions was mainly in the vascular territory supplied by the treated vessel (19 patients; 67.9%), but also in the contralateral MCA (1 patient; 3.6%), and the posterior fossa (4 patients; 14.3%). A significant relationship (P < .03) was found between occurrence of transient ischemic attack (TIA) and appearance of new lesions. Microembolic signals (MES) were detected in 88 patients (92.6%), with no relationship between number of MES and the appearance of new ischemic foci.
CONCLUSION: New ischemic foci were observed in 17.3% of the patients undergoing neuroprotected CAS. Appearance of new ischemic lesions were only significantly related to the occurrence of TIA but not to the number of MES registered or other variables. Despite the encouraging results, the incidence of new ischemic lesions should promote research for safer techniques and devices.
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