New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS)

Summary Background The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI betw...

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Bibliographic Details
Published in:Lancet neurology 2010-04, Vol.9 (4), p.353-362
Main Authors: Bonati, Leo H, MD, Jongen, Lisa M, MD, Haller, Sven, MD, Flach, H Zwenneke, MD, Dobson, Joanna, MSc, Nederkoorn, Paul J, MD, Macdonald, Sumaira, FRCR, Gaines, Peter A, FRCR, Waaijer, Annet, MD, Stierli, Peter, MD, Jäger, H Rolf, FRCR, Lyrer, Philippe A, MD, Kappelle, L Jaap, MD, Wetzel, Stephan G, MD, van der Lugt, Aad, MD, Mali, Willem P, MD, Brown, Martin M, FRCP, van der Worp, H Bart, MD, Engelter, Stefan T, MD
Format: Article
Language:English
Subjects:
Aged
Brain - pathology
Brain - surgery
Brain Ischemia - etiology
Brain Ischemia - pathology
Brain research
Carotid arteries
Carotid Stenosis - mortality
Carotid Stenosis - pathology
Carotid Stenosis - surgery
Carotid Stenosis - therapy
Diffusion Magnetic Resonance Imaging - methods
Endarterectomy, Carotid - adverse effects
Female
Filtration - instrumentation
Follow-Up Studies
Humans
Ischemia
Male
Neurology
Odds Ratio
Prospective Studies
Stents - adverse effects
Stroke
Stroke - pathology
Time Factors
Treatment Outcome
Veins & arteries
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Summary:Summary Background The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI between the two groups. Methods Patients with recently symptomatic carotid artery stenosis enrolled in ICSS were randomly assigned in a 1:1 ratio to receive carotid artery stenting or endarterectomy. Of 50 centres in ICSS, seven took part in the MRI substudy. The protocol specified that MRI was done 1–7 days before treatment, 1–3 days after treatment (post-treatment scan), and 27–33 days after treatment. Scans were analysed by two or three investigators who were masked to treatment. The primary endpoint was the presence of at least one new ischaemic brain lesion on diffusion-weighted imaging (DWI) on the post-treatment scan. Analysis was per protocol. This is a substudy of a registered trial, ISRCTN 25337470. Findings 231 patients (124 in the stenting group and 107 in the endarterectomy group) had MRI before and after treatment. 62 (50%) of 124 patients in the stenting group and 18 (17%) of 107 patients in the endarterectomy group had at least one new DWI lesion detected on post-treatment scans done a median of 1 day after treatment (adjusted odds ratio [OR] 5·21, 95% CI 2·78–9·79; p
ISSN:1474-4422
1474-4465
DOI:10.1016/S1474-4422(10)70057-0