Diffusion-weighted lesions after carotid artery stenting are associated with cognitive impairment

Maggio, Paola; Altamura, Claudia; Landi, Doriana; Migliore, Simone; Lupoi, Domenico; Moffa, Filomena; Quintiliani, Livia; Vollaro, Stefano; Palazzo, Paola; Altavilla, Riccardo; Pasqualetti, Patrizio; Errante, Yuri; Quattrocchi, Carlo Cosimo; Tibuzzi, Francesco; Passarelli, Francesco; Arpesani, Roberto; Giambattista, Guido Di; Grasso, Rosario Francesco; Luppi, Giacomo; Vernieri, Fabrizio

doi:10.1016/j.jns.2013.02.019

Cited by 45 publications

(36 citation statements)

References 36 publications

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“…Multiple previous carotid artery stenting studies have demonstrated that small DWI and FLAIR lesions after stenting are associated with neurocognitive decline. [28][29][30][31] Like our current study, most patients do not display overt clinical neurological deficits, but when tested with detailed neurocognitive tests are found to have decline when compared with their pretreatment states. 31 Although neurocognitive studies are fraught with bias, the finding of increased ipsilateral clinically silent possibly embolic lesions after PED deployment should cause some unease about the risk to patients within the first year of deployment.…”

Section: Strokesupporting

confidence: 62%

Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions

Safain

Roguski

Heller

et al. 2016

Stroke

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Section: Strokesupporting

confidence: 62%

Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions

Safain

Roguski

Heller

et al. 2016

Stroke

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“…Whereas a small study suggests a negative impact on cognitive function, 28 in most studies, no correlation was found with any clinical sequelae.…”

Section: Discussionmentioning

confidence: 81%

Risk Factors for Cerebral Embolization After Carotid Artery Stenting With Embolic Protection

Bijuklic¹,

Wandler²,

Varnakov³

et al. 2013

Circ: Cardiovascular Interventions

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Background-Meta-analyses of randomized trials have shown an increased risk of periprocedural stroke after carotid artery stenting (CAS) compared with carotid endarterectomy, which may differ in specific patient subgroups. Knowledge of risk factors for cerebral embolic lesions during CAS may impact treatment decisions for the individual patient, but these factors have not been extensively studied. We aimed to identify factors predictive for cerebral ischemic lesions during embolic protected CAS. Methods and Results-Preprocedural and postprocedural diffusion-weighted magnetic resonance imaging was performed for evaluation of new cerebral ischemic lesions in 728 (86.9%) of 837 consecutive patients undergoing CAS with cerebral embolic protection. Multivariable logistic regression analyses were performed to identify factors predictive for embolic lesions. New ischemic lesions were found in 32.8% of patients. Age, hypertension, lesion length, lesion eccentricity, and aortic arch type III were significantly associated with new ischemic lesions; calcified lesions were negatively associated. In 25% of these patients embolic lesions were also found in the contralateral hemisphere. Predictive factors for contralateral lesions were age, >50% stenosis of the contralateral internal carotid artery, and an aortic arch type II, with a trend for aortic arch type III. Conclusions-Age, hypertension, lesion morphology, and aortic arch type were predictive for procedural-related cerebral embolic lesions during embolic protected CAS. Age, significant contralateral carotid stenosis, and complex aortic arch type were predictive for bilateral ischemic lesions.

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“…5,7 In addition, these microembolic lesions after interventional procedures negatively impact cognitive functions. 21 Because there is no unanimous opinion regarding the risks associated with harboring such lesions, it might be beneficial to reduce their numbers as much as possible.…”

Section: 23mentioning

confidence: 99%

Microembolism after endovascular coiling of unruptured cerebral aneurysms: incidence and risk factors

Park¹,

Lee

Kim

et al. 2016

JNS

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M icroembolic lesions appearing as high signal intensity (HSI) spots on diffusion-weighted imaging (DWI) and restrictive diffusions on the corresponding apparent diffusion coefficient (ADC) maps are often seen following a variety neurovascular procedures. Reportedly, 10% to 76.5% of DWI studies obtained after endovascular coiling of unruptured intracranial aneurysms (UIAs) show such microembolic spots (Fig. 1). [2][3][4]8,9,15,22,[24][25][26] Most patients who show HSI spots are asymptomatic, and the clinical significance of such spots remains controversial. However, the HSI spots reflect the presence of damaged tissue, 5,7,12,15 and their associated potential risks cannot be ignored.This study was conducted to analyze the current incidence of postprocedural DWI HSI lesions at our institution and to explore the possible risk factors for microembolic lesions visible as HSI spots on DWI after endovascular coiling of UIAs. Methods Patient PopulationOur local institutional review board approved this retrospective study, and the requirement for patient informed consent for data collection and analyses was waived. We used our neurointerventional database to identify a total of 293 consecutive patients who had presented with a UIA for endovascular treatment between July 2011 and June 2013. Among 293 patients, we excluded 13 patients in whom the aneurysm was treated with parent artery trapping without endosaccular coiling and 2 other patients in whom endovascular management was unsuccessful due to selection aBBreViatiONS ACT = activated clotting time; ADC = apparent diffusion coefficient; BMI = body mass index; DM = diabetes mellitus; DWI = diffusion-weighted imaging; HSI = high signal intensity; PRU = P2Y12 reaction unit; UIA = unruptured intracranial aneurysm. OBJectiVe The incidence and risk factors of microembolic lesions on MR diffusion-weighted imaging (DWI) were analyzed after the endovascular coiling of unruptured intracranial aneurysms (UIAs). MethOdS Data obtained from 271 consecutive patients (70 men and 201 women; median age 57 years; range 23-79 years) who presented with UIA for coil embolization between July 2011 and June 2013 were analyzed. Two independent reviewers examined the DWI and apparent diffusion coefficient maps obtained the following day for the presence of restrictive diffusion spots and counted the number of spots. Multivariate analysis was then performed to identify independent risk factors for developing microembolism following the coiling of an aneurysm. reSultS Microembolic lesions were noted in 101 of 271 patients (37.3%). The results of the multivariate analysis showed that the following factors significantly influenced the risk for microembolism: age, diabetes, previous history of ischemic stroke, high-signal FLAIR lesions in the white matter, multiple aneurysms, and the insertion of an Enterprise stent (all ORs > 1.0 and all p values < 0.05). Previously known risk factors such as prolonged procedure duration, aneurysm size, and decreased antiplatelet function did not show any signific...

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Diffusion-weighted lesions after carotid artery stenting are associated with cognitive impairment

Cited by 45 publications

References 36 publications

Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions

Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions

Risk Factors for Cerebral Embolization After Carotid Artery Stenting With Embolic Protection

Microembolism after endovascular coiling of unruptured cerebral aneurysms: incidence and risk factors

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