Ischemic Brain Lesions After Carotid Artery Stenting Increase Future Cerebrovascular Risk

Abstract Background Brain lesions on diffusion-weighted imaging (DWI) are frequently found after carotid artery stenting (CAS), but their clinical relevance remains unclear. Objectives This study sought to investigate whether periprocedural ischemic DWI lesions after CAS or carotid endarterectomy (C...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2015-02, Vol.65 (6), p.521-529
Main Authors: Gensicke, Henrik, MD, van der Worp, H. Bart, PhD, Nederkoorn, Paul J., PhD, Macdonald, Sumaira, PhD, Gaines, Peter A., MBChB, van der Lugt, Aad, MD, Mali, Willem P.Th.M., MD, Lyrer, Philippe A., MD, Peters, Nils, MD, Featherstone, Roland L., PhD, de Borst, Gert J., MD, Engelter, Stefan T., MD, Brown, Martin M., MD, Bonati, Leo H., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Blood Vessel Prosthesis Implantation - adverse effects
Brain Ischemia - diagnosis
Brain Ischemia - epidemiology
Brain Ischemia - etiology
Brain research
Cardiology
Cardiovascular
Cardiovascular disease
carotid stenosis
Carotid Stenosis - diagnosis
Carotid Stenosis - surgery
Confidence intervals
DWI lesions
endarterectomy
Endarterectomy, Carotid - adverse effects
Female
Follow-Up Studies
Humans
Incidence
Internal Medicine
Ischemia
long-term outcome
Magnetic Resonance Imaging
Male
Medical imaging
Middle Aged
Netherlands - epidemiology
Original Investigation
Patients
Postoperative Complications
Prognosis
Prospective Studies
Risk Factors
stenting
Stents
Studies
Time Factors
United Kingdom - epidemiology
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Summary:Abstract Background Brain lesions on diffusion-weighted imaging (DWI) are frequently found after carotid artery stenting (CAS), but their clinical relevance remains unclear. Objectives This study sought to investigate whether periprocedural ischemic DWI lesions after CAS or carotid endarterectomy (CEA) are associated with an increased risk of recurrent cerebrovascular events. Methods In the magnetic resonance imaging (MRI) substudy of ICSS (International Carotid Stenting Study), 231 patients with symptomatic carotid stenosis were randomized to undergo CAS (n = 124) or CEA (n = 107). MRIs were performed 1 to 7 days before and 1 to 3 days after treatment. The primary outcome event was stroke or transient ischemic attack in any territory occurring between the post-treatment MRI and the end of follow-up. Time to occurrence of the primary outcome event was compared between patients with (DWI+) and without (DWI–) new DWI lesions on the post-treatment scan in the CAS and CEA groups separately. Results Median time of follow-up was 4.1 years (interquartile range: 3.0 to 5.2). In the CAS group, recurrent stroke or transient ischemic attack occurred more often among DWI+ patients (12 of 62) than among DWI– patients (6 of 62), with a cumulative 5-year incidence of 22.8% (standard error [SE]: 7.1%) and 8.8% (SE: 3.8%), respectively (unadjusted hazard ratio: 2.85; 95% confidence interval: 1.05 to 7.72; p = 0.04). In DWI+ and DWI– patients, 8 and 2 events, respectively, occurred within 6 months after treatment. In the CEA group, there was no difference in recurrent cerebrovascular events between DWI+ and DWI– patients. Conclusions Ischemic brain lesions discovered on DWI after CAS seem to be a marker of increased risk for recurrent cerebrovascular events. Patients with periprocedural DWI lesions might benefit from more aggressive and prolonged antiplatelet therapy after CAS. (A Randomised Comparison of the Risks, Benefits and Cost Effectiveness of Primary Carotid Stenting With Carotid Endarterectomy: International Carotid Stenting Study; ISRCTN25337470 )
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2014.11.038