Silent Ischemia after Neuroprotected Percutaneous Carotid Stenting: A Diffusion-Weighted MRI Study
P. Piñeroa,
A. Gonzálezb,
A. Mayolb,
E. Martínezc,
J.R. González-Marcosc,
F. Bozad,
A. Cayuelae and
A. Gil-Peraltac
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
View larger version (70K):
[in a new window]
|
Fig. 1. A, MR angiography of the right common carotid artery before carotid artery stent (CAS) placement, showing a severe stenosis of the proximal internal carotid artery.
B, Diffusion-weighted image (DWI) obtained at the same time shows no abnormalities.
C, DWI after CAS with a new ipsilateral lesion in the deep territory of the ipsilateral middle cerebral artery.
| |
View larger version (134K):
[in a new window]
|
Fig. 2. A–D, Normal axial diffusion-weighted image (DWI).
E–K, Post-carotid artery stent placement DWI (axial, sagittal, and coronal) with multiple and bilateral cortical new ischemic lesions in the territory of both middle cerebral artery and contralateral anterior and posterior arteries.
| |
View larger version (64K):
[in a new window]
|
Fig. 3. A, MR angiography of the right common carotid artery before carotid artery stent placement (CAS) with a tandem lesion in the proximal internal carotid artery.
B and C, Diffusion-weighted image before (B) and after CAS (C), showing a new lesion <5 mm in the superficial territory of the contralateral middle cerebral artery.
| |
View larger version (110K):
[in a new window]
|
Fig. 4. A, Right common carotid artery MR angiography before carotid artery stent placement (CAS). Ulcerated stenosis of the proximal internal carotid artery (ICA).
B–D, Axial diffusion-weighted images (B and C) and apparent diffusion coefficient map (D). Before CAS, ischemic focal lesion >10 mm in the left caudate nucleus, contralateral to the treated ICA.
E and F, After CAS, a new lesion is shown in the contralateral posterior fossa.
| |
View larger version (66K):
[in a new window]
|
Fig. 5. A, Normal diffusion-weighted image before carotid artery stent placement.
B, After a successful procedure, a new ischemic cortical lesion >10 mm is seen in the contralateral posterior artery territory.
| |
