Background and Purpose: Carotid artery stenting (CAS) is associated with the risk of periprocedural embolic events. The procedural risk may vary with plaque characteristics. We aimed at determining the impact of carotid plaque surface irregularity on the risk of cerebral embolism during CAS. Methods: Solid microembolic signals (MES) during CAS for symptomatic carotid stenosis were assessed by means of dual-frequency transcranial Doppler ultrasound. Study endpoint was the number of solid MES during CAS in 12 patients with irregular carotid stenosis compared to 12 matched patients with smooth carotid stenosis. Results: A total of 438 solid MES were detected. The cumulative number of solid MES was 329 in patients with irregular plaques and 109 in those with smooth plaques. The proportion of subjects in whom solid MES were detected was higher in the irregular plaque group (11/12) than in the smooth plaque group (5/12) (p = 0.030). The numbers of solid MES per CAS procedure and per hour of CAS procedure were both higher in patients with irregular plaques than in those with smooth plaques (p = 0.008 and 0.015, respectively). Conclusions: Carotid plaque surface irregularity predicts solid cerebral embolism during stenting of symptomatic carotid artery stenosis.

Background: Carotid stenting carries a risk of periprocedural stroke. We aimed at determining predictors of cerebral ischemic events associated with stenting for symptomatic carotid stenosis. Methods: 127 patients who had been studied by diffusion-weighted MR imaging (DWI) before and on the day after carotid stenting were included. Six clinical variables and 5 variables characterizing the target carotid artery and aortic atherosclerosis were analyzed as potential risk factors for new ipsilateral DWI lesions after stenting. Results: Among all variables assessed, only age, length of stenosis and carotid intima-media thickness (IMT) significantly modified the risk of new lesions after stenting. Age ≧68 years, stenosis ≧15 mm and IMT ≧1.3 mm were identified as the best thresholds to predict new lesions. In the subgroup of patients ≧68 years with carotid stenosis ≧15 mm in length and IMT ≧1.3 mm, the risk of new lesions was markedly higher than in patients to whom no more than two of these factors applied (odds ratio 7.250, 95% CI 1.612–34.513, p = 0.005). The use of this simple predictive model correctly identified patients who had new lesions after stenting with high specificity (0.96) and a negative predictive value (0.83), while the positive predictive value was moderate (0.60) and sensitivity was low (0.23). Conclusions: The risk of stenting for symptomatic carotid stenosis may vary with clinical and morphological patient characteristics. Further research is needed to validate these results and to evaluate the safety of stenting versus endarterectomy in specific patient subgroups.

The strong negative correlation of ADC and MTR values suggest a strong influence of proteins on proton diffusion in intracranial cysts. The phenomena can be explained by macromolecules that bind nearby protons in their vicinity.

Zusammenfassung Die fibromuskul?re Dysplasie der proximalen A. carotis interna ist eine seltene und unterdiagnostizierte Ursache von Schlaganf?llen. Angiografisch hat sie die Form eines Septums bzw. einer Membran. Als Schlaganfallmechanismus wird eine Flussturbulenz und Blutstase distal des Septums mit konsekutiver Thrombusbildung angenommen. Die Thrombozytenaggregantionshemmung zur Schlaganfallpr?vention ist in dem Fall wenig wirksam. Wir berichten ?ber einen jungen Erwachsenen mit der Diagnose einer proximalen fibromuskul?ren Dysplasie der rechten A. carotis interna. Der Patient erlitt ?ber Jahre rezidivierende thromboembolische Hirninfarkte im gleichen Gef??territorium. Die Schlaganf?lle wurden zun?chst als kryptogen gedeutet. Unser Fall zeigt, dass bei unklaren rezidivierenden Schlaganf?llen im gleichen Gef??territorium an die seltene Ursache einer proximalen fibromuskul?ren Dysplasie gedacht werden sollte.