Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy

BACKGROUND AND PURPOSE—Complex vascular anatomy might increase the risk of procedural stroke during carotid artery stenting (CAS). Randomized controlled trial evidence that vascular anatomy should inform the choice between CAS and carotid endarterectomy (CEA) has been lacking. METHODS—One-hundred ei...

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Bibliographic Details
Published in:Stroke (1970) 2017-05, Vol.48 (5), p.1285-1292
Main Authors: Müller, Mandy D, Ahlhelm, Frank J, von Hessling, Alexander, Doig, David, Nederkoorn, Paul J, Macdonald, Sumaira, Lyrer, Philippe A, van der Lugt, Aad, Hendrikse, Jeroen, Stippich, Christoph, van der Worp, H Bart, Richards, Toby, Brown, Martin M, Engelter, Stefan T, Bonati, Leo H
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aorta, Thoracic - diagnostic imaging
Brain Ischemia - etiology
Carotid Artery, Internal - diagnostic imaging
Carotid Stenosis - surgery
Cerebral Angiography - methods
Computed Tomography Angiography - methods
Diffusion Magnetic Resonance Imaging - methods
Endarterectomy, Carotid - adverse effects
Female
Humans
Magnetic Resonance Angiography - methods
Magnetic Resonance Imaging - methods
Male
Middle Aged
Outcome and Process Assessment, Health Care
Risk
Stents
Stroke - etiology
Vascular Surgical Procedures - adverse effects
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Summary:BACKGROUND AND PURPOSE—Complex vascular anatomy might increase the risk of procedural stroke during carotid artery stenting (CAS). Randomized controlled trial evidence that vascular anatomy should inform the choice between CAS and carotid endarterectomy (CEA) has been lacking. METHODS—One-hundred eighty-four patients with symptomatic internal carotid artery stenosis who were randomly assigned to CAS or CEA in the ICSS (International Carotid Stenting Study) underwent magnetic resonance (n=126) or computed tomographic angiography (n=58) at baseline and brain magnetic resonance imaging before and after treatment. We investigated the association between aortic arch configuration, angles of supra-aortic arteries, degree, length of stenosis, and plaque ulceration with the presence of ≥1 new ischemic brain lesion on diffusion-weighted magnetic resonance imaging (DWI+) after treatment. RESULTS—Forty-nine of 97 patients in the CAS group (51%) and 14 of 87 in the CEA group (16%) were DWI+ (odds ratio [OR], 6.0; 95% confidence interval [CI], 2.9–12.4; P
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.116.014612