Cerebral Ischemia Detected with Diffusion-Weighted MR Imaging after Stent Implantation in the Carotid Artery

• Published in: American journal of neuroradiology : AJNR Vol. 23; no. 2; pp. 200 - 207
• Main Authors: Jaeger, Horst J, Mathias, Klaus D, Hauth, Elke, Drescher, Robert, Gissler, H. Martin, Hennigs, Svenja, Christmann, Andreas
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01-02-2002; American Society of Neuroradiology
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Brain; Brain Ischemia - diagnosis; Brain Ischemia - etiology; Brain Ischemia - physiopathology; Brain Ischemia - therapy; Carotid Arteries - pathology; Cerebral Angiography; Diffusion; Diseases of the nervous system; Female; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Nervous System - physiopathology; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stents - adverse effects; Human; Nervous system diseases; Stroke; Instrumentation therapy; Stenosis; Cardiovascular disease; Instrumental dilatation; Nuclear magnetic resonance imaging; Stent; Embolism; Cerebral disorder; Microembolism; Arterial disease; Vascular disease; Ischemia; Carotid; Central nervous system disease; Medical imagery; Adult; Complication; Diffusion; Cerebrovascular disease
• ISSN: 0195-6108; 1936-959X

Concern regarding the safety of stent implantation in the carotid artery exists because of the risk of cerebral embolization during the procedure. The purpose of this prospective study was to determine the incidence of new areas of cerebral ischemia, as detected by using diffusion-weighted MR imaging after stent implantation in the carotid artery.
Diffusion-weighted MR imaging of the brain was performed in 67 patients with 70 high-grade stenoses of the carotid artery before and 24 hours after stent implantation.
The neurologic status of the patients was unchanged after 69 of 70 procedures. During one procedure, symptomatic cerebral embolization occurred. Diffusion-weighted MR images showed new ipsilateral lesions after stent implantation in 20 patients (29%), including the symptomatic patient, and new contralateral lesions in six patients (9%). Fifty-two of 59 postprocedural lesions occurred in the vascular territory supplied by the treated vessel. The occurrence of new postprocedural ipsilateral lesions was not significantly correlated with patient demographic data, characteristics of the stenoses, or details of the procedure.
In 29% of the procedures, stent implantation in the carotid artery was associated with new areas of cerebral ischemia, as detected by using diffusion-weighted MR images; these findings indicated the occurrence of cerebral microemboli during such procedures. In all patients except one, the new lesions were clinically silent.