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Research ArticleBrain

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

Horst J. Jaeger, Klaus D. Mathias, Elke Hauth, Robert Drescher, H. Martin Gissler, Svenja Hennigs and Andreas Christmann
American Journal of Neuroradiology February 2002, 23 (2) 200-207;
Horst J. Jaeger
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Klaus D. Mathias
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Elke Hauth
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Robert Drescher
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H. Martin Gissler
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Svenja Hennigs
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Andreas Christmann
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  • Fig 1.
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    Fig 1.

    Images obtained in a 70-year-old man with an asymptomatic stenosis of the carotid artery.

    A, Right anterior oblique angiogram shows a 94% stenosis of the right ICA.

    B, Right anterior oblique angiogram shows the result after stent implantation.

    C, Postprocedural axial diffusion-weighted MR image (6000/103/1) shows a new ipsilateral lesion (<5 mm) in the cortical territory of the MCA (arrow).

  • Fig 2.
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    Fig 2.

    Images obtained in a 86-year-old man with a symptomatic stenosis of the carotid artery.

    A, Left anterior oblique angiogram (transbrachial approach) shows an 87% stenosis of the left ICA.

    B, Left anterior oblique angiogram shows the result after stent implantation.

    C, Postprocedural axial diffusion-weighted MR image (6000/103/1) shows six new ipsilateral lesions (5–10 mm) in the cortical territory of the ACA (arrow).

  • Fig 3.
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    Fig 3.

    Images obtained in a 73-year-old woman with a symptomatic stenosis of the carotid artery.

    A, Left anterior oblique angiogram shows an 85% stenosis of the left ICA.

    B, Left anterior oblique angiogram shows the result after stent implantation.

    C, Postprocedural axial diffusion-weighted MR image (6000/103/1) shows eight new ipsilateral lesions (15–20 mm) in the cortical territory of the MCA (arrow).

    D, Postprocedural axial T2-weighted MR image (5700/119/1) obtained at a corresponding level shows a new area of hyperintensity (arrow) that was not present in C.

  • Fig 4.
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    Fig 4.

    Images obtained in a 76-year-old woman with a symptomatic stenosis of the carotid artery.

    A, Left anterior oblique angiogram shows a 79% stenosis of the left ICA.

    B, Left anterior oblique angiogram shows the result after stent implantation.

    C, Lateral angiogram shows the intracranial circulation of the treated side after a procedure with a nonocclusive embolus in a branch of the MCA (arrow). The patient was symptomatic during the whole procedure. An angiogram of the intracranial circulation obtained after the infusion of 100,000 IU of urokinase into the ICA demonstrated complete disappearance of the embolus (not shown).

    D, Postprocedural axial diffusion-weighted MR image (6000/103/1) shows eight new ipsilateral lesions (5–10 mm) in the cortical territory of the MCA (arrow).

Tables

  • Figures
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    TABLE 1:

    Patient characteristics

    CharacteristicsPatientsP Value*
    All (n = 67)With Positive DW Findings (n = 47)With Negative DW Findings (n = 20)
    Demographic
     Sex.382
      Male47 (70)31 (66)16 (80)NA
      Female20 (30)16 (34)4 (20)NA
     Age (y)†67 ± 9.1 (44–86)66 ± 9.3 (44–86)70 ± 7.8 (57–86).076
    Medical history
     Hypertension57 (85)39 (83)18 (90).711
     Coronary artery disease45 (67)30 (64)15 (75).412
     Peripheral vascular disease35 (52)26 (55)9 (45).594
     Diabetes mellitus28 (42)21 (45)7 (35).591
     Hypocholesterolemia53 (79)39 (83)14 (70).325
     Cardiac arrhythmia20 (30)14 (30)6 (30)>.99
    T2-weighted MR imaging
     Cerebral atrophy46 (69)31 (66)15 (75).571
     Subcortical arteriosclerotic encephalopathy58 (87)41 (87)17 (85)>.99
     Cerebral infarction
      Ipsilateral13 (19)8 (17)5 (25).507
      Contralateral9 (13)7 (15)2 (10).714
    • Note.—Data in parentheses are percentages, unless otherwise specified.

    • * NA indicates not applicable.

    • † Data are the mean ± SD. Data in parentheses are the range.

    • View popup
    TABLE 2:

    Characteristics of the stenoses

    CharacteristicProceduresP Value*
    All (n = 70)With Positive DW Findings (n = 50)With Negative DW Findings (n = 20)
    Symptoms
     Present52 (75)38 (76)14 (70).763
     Present in the last 3 mo42 (60)30 (60)12 (60)>.99
     Absent18 (25)12 (24)6 (30).763
    Cause.408
     Atherosclerotic63 (90)45 (90)18 (90)NA
     Surgery6 (9)5 (10)1 (5)NA
     Irradiation1 (1)0 (0)1 (5)NA
    Side.285
     Right40 (57)31 (62)9 (45)NA
     Left30 (43)19 (38)11 (55)NA
    Grade (%)†84 ± 7.9 (60–98)83 ± 7.3 (60–98)86 ± 9.3 (62–98).131
    Classification.493
     0–29%0 (0)0 (0)0 (0)NA
     30–69%2 (3)1 (2)1 (5)NA
     70–99%68 (97)49 (98)19 (95)NA
    Location.182
     ICA at bifurcation35 (50)24 (48)11 (55)NA
     Proximal ICA32 (46)25 (50)7 (35)NA
     CCA3 (4)1 (2)2 (10)NA
    Length.259
     <1 cm47 (67)36 (72)11 (55)NA
     >1 cm23 (33)14 (28)9 (45)NA
    Morphology.796
     Eccentric37 (53)27 (54)10 (50)NA
     Concentric33 (47)23 (46)10 (50)NA
    Ulcerations17 (24)14 (28)3 (15).359
    Contralateral ICA occlusion6 (9)5 (10)1 (5).666
    • Note.—Data in parentheses are percentages, unless otherwise specified.

    • * NA indicates not applicable.

    • † Data are the mean ± SD. Data in parentheses are the range.

    • View popup
    TABLE 3:

    Details of procedures

    DetailProceduresP Value*
    All (n = 70)With Positive DW Findings (n = 50)With Negative DW Findings (n = 20)
    Access.194
     Transfemoral67 (96)49 (98)18 (90)NA
     Transbrachial3 (4)1 (2)2 (10)NA
    Technique.107
     OTW61 (87)46 (92)15 (75)NA
     Long sheath9 (13)4 (8)5 (25)NA
    Predilation65 (93)47 (94)18 (90).619
    Type of Wallstent.551
     Rolling membrane10 (14)6 (12)4 (20)NA
     Easy44 (63)33 (66)11 (55)NA
     OTW16 (23)11 (22)5 (25)NA
    Location of stent.122
     ICA9 (13)6 (12)3 (15)NA
     ICA and/or CCA59 (84)44 (88)15 (75)NA
     CCA2 (3)0 (0)2 (10)NA
    Postdilation61 (87)44 (88)17 (85).708
    Grade of remaining stenosis (%)†5.8 ± 7.7 (0–29)5.5 ± 6.8 (0–29)6.6 ± 9.8 (0–29).889
    • Note.—Data in parentheses are percentages, unless otherwise specified.

    • * NA indicates not applicable.

    • † Data are the mean ± SD. Data in parentheses are the range.

    • View popup
    TABLE 4:

    Lesion characteristics on DW MR images of the brain

    CharacteristicLesion
    Ipsilateral PreproceduralContralateral PostproceduralIpsilateralContralateral
    Procedures with lesions*10 (14 [7, 25])1 (1 [0, 7])20 (29 [19, 41])6 (9 [4, 17])
    No. of lesions
     Total241527
     Average2.4NA2.61.2
     Range1–6NA1–81–2
    Size
     <5 mm10 (42)0 (0)36 (69)6 (86)
     5–10 mm7 (29)0 (0)11 (21)0 (0)
     >10 mm7 (29)1 (100)5 (10)1 (14)
    Location
     Vertical distribution
      Upper area of brain15 (63)1 (100)27 (52)4 (57)
      Middle area of brain9 (38)0 (0)20 (39)3 (43)
      Lower area of brain0 (0)0 (0)5 (10)0 (0)
     Horizontal distribution
      Cortical or subcortical area24 (1000)1 (100)50 (96)6 (86)
      Deep area0 (0)0 (0)2 (4)1 (14)
     Cerebral distribution
      Frontal lobe0 (0)0 (0)4 (8)3 (43)
      Parietal lobe23 (96)1 (100)38 (73)2 (29)
      Temporal lobe1 (4)0 (0)5 (10)0 (0)
      Occipital lobe0 (0)0 (0)3 (6)1 (14)
      Basal ganglia0 (0)0 (0)1 (2)0 (0)
      Thalamus0 (0)0 (0)1 (2)1 (14)
    Vascular distribution†
     ACA cortical branches1 (4)1 (100)5 (10)2 (29)
     ACA deep branches0 (0)0 (0)1 (2)0 (0)
     MCA cortical branches23 (96)0 (0)42 (82)3 (43)
     MCA deep branches0 (0)0 (0)0 (0)0 (0)
     PCA cortical branches0 (0)0 (0)3 (6)1 (14)
     PCA deep branches0 (0)0 (0)1 (2)1 (14)
    • Note.—Total of procedures was 70. Data in parentheses are percentages, unless otherwise specified. NA indicates not applicable.

    • * Data in brackets are the 95% confidence intervals.

    • † PCA indicates posterior cerebral artery.

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American Journal of Neuroradiology: 23 (2)
American Journal of Neuroradiology
Vol. 23, Issue 2
1 Feb 2002
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Cerebral Ischemia Detected with Diffusion-Weighted MR Imaging after Stent Implantation in the Carotid Artery
Horst J. Jaeger, Klaus D. Mathias, Elke Hauth, Robert Drescher, H. Martin Gissler, Svenja Hennigs, Andreas Christmann
American Journal of Neuroradiology Feb 2002, 23 (2) 200-207;
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  • Impact of Asymptomatic Cerebral Lesions in Diffusion-Weighted Magnetic Resonance Imaging After Carotid Artery Stenting
  • The PROFI Study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): A Prospective Randomized Trial
  • New Ischemic Brain Lesions on Diffusion-Weighted MRI after Carotid Artery Stenting with Filter Protection: Frequency and Relationship with Plaque Morphology
  • The Influence of Carotid Artery Catheterization Technique on the Incidence of Thromboembolism during Carotid Artery Stenting
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  • Volume and Composition of Emboli in Neuroprotected Stenting of the Carotid Artery
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  • Optimal Treatment of Carotid Artery Disease
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  • Silent Cerebral Ischemia Detected With Diffusion-Weighted Imaging in Patients Treated With Protected and Unprotected Carotid Artery Stenting
  • Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: A Joint Statement from the American Academy of Neurology, the American Association of Neurological Surgeons, the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, the Congress of Neurological Surgeons, the AANS/CNS Cerebrovascular Section, and the Society of Interventional Radiology
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Horst J. Jaeger, Klaus D. Mathias, Elke Hauth, Robert Drescher, H. Martin Gissler, Svenja Hennigs, Andreas Christmann
Cerebral Ischemia Detected with Diffusion-Weighted MR Imaging after Stent Implantation in the Carotid Artery
American Journal of Neuroradiology Feb 2002, 23 (2) 200-207;

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