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Silent ischemia after neuroprotected percutaneous carotid stenting: A diffusion-weighted MRI study

2007; Elsevier BV; Volume: 45; Issue: 4 Linguagem: Inglês

10.1016/j.jvs.2007.02.020

1097-6809

Paula Piñero, Andrés González‐Mandly, Antonio Mayol,

Cardiovascular Health and Disease Prevention

Conclusions: New ischemic foci detected by diffusion-weighted imaging (DWI) occurred in 17% of cases after carotid artery stenting. DWI lesions did not correlate with microemboli signals detected by transcranial Doppler, but did correlate with occurrence of transient ischemic attack (TIA). Summary: Carotid artery stenting using a distal filter embolic protection device was performed in 162 patients (75.3% symptomatic). Four different types of embolic protection devices were used: EPI and EZ filter wires (Boston Scientific/Target Therapeutics, Fremont, Calif), Spider (ev3, Plymouth, Minn), and Accunet (Guidant, Santa Clara, Calif). DWI was performed ≤72 hours of carotid artery stenting and 24 hours after stenting. Middle cerebral artery transcranial Doppler ultrasonography was used to monitor 95 (58.6%) of the 162 patients to detect microemboli ipsilateral to the stented carotid artery. After stenting, 28 patients (7.3%) showed 58 new DWI ischemic lesions, and 13 (46.4%) had multiple DWI lesions. A total of 67.9% of new lesions were in the vascular territory supplied by the carotid artery treated. DWI lesions also occurred in the contralateral middle cerebral artery in one patient and in the posterior fossa of four patients. The appearance of new DWI lesions and the occurrence of TIA was significantly correlated (P < .03). Of the patients studied with transcranial Doppler, microembolic signals were detected in 92.6%. There was no relationship between microembolic signals and new DWI lesions. There was also no relationship between new DWI lesions and patient demographics, clinical presentation, vascular risk factors, plaque characteristics, or type of stent or cerebral protection device. Comment: This is another report documenting a high rate of new ischemic foci after carotid artery stenting. Clearly, there is room for improvement in the design of neuroprotection devices as adjuncts to carotid artery stenting.