Article Figures & Data
Figures
- 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.
- 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.
- 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.
- 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.
- 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.
Tables
n (%) No. of patients 162 (100) Men 131 (80.9) Women 31 (19.1) Mean age/range (y) 68.5 (33–86) Symptomatic patients 122 (75.3) TIA/Amaurosis fugax 64 (39.5) Minor stroke 58 (35.8) Asymptomatic patients 40 (24.7) Vascular risks factors Diabetes 79 (48.8) Hypertesion 127 (78.4) Hyperlipidemia 99 (61.1) Cigarette smoking 81 (50) Coronary artery disease 53 (32.7) Peripheral vascular disease 49 (30.2) Note:—TIA indicates transient ischemic attacks.
n (%) Left ICA stenosis 70 (43.2) Right ICA stenosis 92 (56.8) % Stenosis (treated vessel) 70–85 59 (36.4) 86–99 79 (48.8) >99 24 (14.8) % Contralateral stenosis <70 112 (69.1) 70–99 24 (14.8) 100 26 (16.1) Ulcerated plaque 71 (44.1) Calcified plaque 80 (49.4) Functioning AcomA 122 (75.3) Functioning PcomA 72 (47.1) Intracranial lesion 13 (8) Plaque <1 cm 48 (29.6) ≥1 cm 114 (70.4) Position <0.5 mm 130 (80.1) ≥0.5 mm 32 (19.9) Dissection post-TPA 25 (15.4) Transient symptomatic vasospasm 42 (25.9) Note:—ICA indicates internal carotid artery; AcomA, anterior communicating artery; PcomA, posterior communicating artery; TPA, transluminal percutaneous angioplasty.
- Table 3:
Microembolic signals (MES) detected in phases of carotid angioplasty and stenting (CAS) as determined by transcranial Doppler
Phase of CAS No. of MES Median (P25–P75) 1 6 (3–11) 2 27 (13–47) 3 0 (0–1) Total 58 (27–94) Note:—Of 95 cases, 88 (92.6%) were positive, 7 (7.4%) were negative.
No. of new lesions 58 (28 patients) No. of single lesions 15 (15 patients) No. of multiple lesions 43 (13 patients) Vascular distribution Ipsilateral MCA territory 19 (67.9) Contralateral MCA 1 (3.6) Posterior fossa 4 (14.3) Contralateral MCA + posterior fossa 1 (3.6) Ipsilateral MCA + contralateral MCA 3 (10.6) Location Cortical 14 (50) Subcortical 1 (3.6) Cortical + subcortical 5 (17.9) Border zone 3 (10.7) Deep wm 3 (10.7) Cortical + deep wm 1 (3.6) Cortical + subcortical + deep wm 1 (3.6) Size <5 mm 16 (57.1) 5–10 mm 8 (28.6) >10 mm 3 (10.7) <5 and >10 mm 1 (3.6) Anatomic location Frontal 3 (10.7) Parietal 12 (42.9) Temporal 1 (3.6) Occipital 2 (7.1) Basal ganglia 4 (14.3) Frontal + parietal + occipital 2 (7.1) Parietal + occipital + basal ganglia 1 (3.6) Cerebellum 3 (10.7) Note:—MCA indicates middle cerebral artery; wm, white matter. Values in parentheses are percentages.
In this issue
Jump to section
Related Articles
Cited By...
- Progressive changes in cerebral perfusion after carotid stenting: a dynamic susceptibility contrast perfusion weighted imaging study
- Can Doppler Flow Parameters of Carotid Stenosis Predict the Occurrence of New Ischemic Brain Lesions Detected by Diffusion-Weighted MR Imaging after Filter-Protected Internal Carotid Artery Stenting?
- Periprocedural Hemodynamic Depression Is Associated With a Higher Number of New Ischemic Brain Lesions After Stenting in the International Carotid Stenting Study-MRI Substudy
- Strategies of Clopidogrel Load and Atorvastatin Reload to Prevent Ischemic Cerebral Events in Patients Undergoing Protected Carotid Stenting: Results of the Randomized ARMYDA-9 CAROTID (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting) Study
- Unprotected Carotid Artery Stenting in Symptomatic Patients with High-Grade Stenosis: Results and Long-Term Follow-Up in a Single-Center Experience
- New Ischemic Brain Lesions on Diffusion-Weighted MRI after Carotid Artery Stenting with Filter Protection: Frequency and Relationship with Plaque Morphology
- Are Distal Protection Devices 'Protective' During Carotid Angioplasty and Stenting?
- Internal Carotid Artery Stenting in Patients with Near Occlusion: 30-Day and Long-Term Outcome
- Ischemic Cerebrovascular Complications of Cardiac Procedures
- Volume and Composition of Emboli in Neuroprotected Stenting of the Carotid Artery
- Assessing Carotid Revascularization: Should We Abandon the Neurological Examination?
- New Brain Lesions After Carotid Stenting Versus Carotid Endarterectomy: A Systematic Review of the Literature
- Risk Factors and Neurological Consequences of Syncopes Induced by Internal Carotid Artery Angioplasty
- Response to Letter by Wong and Poon
- New MRI Brain Lesions as Surrogate Outcome for Carotid Stenting With and Without Cerebral Protection
- Advances in Interventional Neuroradiology 2006