New Brain Lesions After Carotid Stenting Versus Carotid Endarterectomy

Schnaudigel, Sonja; Gröschel, Klaus; Pilgram, S. M.; Kastrup, Andreas

doi:10.1161/strokeaha.107.500603

Cited by 279 publications

(280 citation statements)

References 62 publications

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“…[1][2][3][4] This has led to the development and widespread application of cerebral protection devices. 5,6 The most widely used devices are those based on distal filter placement that capture emboli dislodged from plaque; however, their application may result in additional complications.…”

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confidence: 99%

New Ischemic Brain Lesions on Diffusion-Weighted MRI after Carotid Artery Stenting with Filter Protection: Frequency and Relationship with Plaque Morphology

Stojanov

Ilić²,

Bošnjaković³

et al. 2011

AJNR Am J Neuroradiol

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confidence: 99%

New Ischemic Brain Lesions on Diffusion-Weighted MRI after Carotid Artery Stenting with Filter Protection: Frequency and Relationship with Plaque Morphology

Stojanov

Ilić²,

Bošnjaković³

et al. 2011

AJNR Am J Neuroradiol

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“…This rate is lower than that of previous studies (28,29). A previous meta-analysis found a significantly lower incidence (33%) of new periprocedural ischemic lesions in protected patients than in unprotected patients (45%) (29).…”

Section: Outcome Based On Carotid Hr-mri Findingsmentioning

confidence: 54%

The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

Jeong

Kwak

Hwang

et al. 2018

J Korean Soc Radiol

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Purpose:The aim of this study was to determine the safety of the carotid artery stenting (CAS) procedure, using an embolic protection device which is based on the presence of unstable plaques on carotid MR imaging in patients who presented with severe carotid artery stenosis. Materials and Methods: This prospective study assessed 102 consecutive patients who had been noted with severe carotid stenosis. These patients underwent a preprocedural carotid MR imaging, and a periprocedural diffusion-weighted imaging (DWI) after the CAS. The unstable plaque on the carotid MR imaging was defined as characterized as intraplaque hemorrhage (IPH), thin/ruptured fibrous caps, or ulcers. We analyzed the incidence of the noted periprocedural ipsilateral ischemic events on the DWI, and noted the primary outcomes within 30 days of the CAS. Results: In the study, it is noted that 50 patients (49.0%) had IPH, 84 patients (82.4%) had thin/ruptured fibrous caps, and 43 patients (42.2%) had ulcers as seen on the carotid plaque MR imaging. The IPH was more common in the symptomatic group than in the asymptomatic group (58.7% vs. 41.1%, p = 0.12). Overall, the DWI was positive after CAS in 25.5% of cases. Additionally, the combined rate of 30-day stroke, myocardial infarction, or death was recorded at 3.9%. The new periprocedural ischemic lesions on the DWI were characteristically more frequently observed in the symptomatic group (17/46, 37.0%) than in the asymptomatic group (9/56, 16.1%) (p = 0.03). There was no significant difference in the primary outcome of the CAS, based on the type of unstable plaque of IPH, thin/ruptured fibrous caps, or ulcers. Conclusion:The protected CAS appears to be safe, regardless of the noted unstable plaque findings as seen on the carotid MR imaging. In this case, because of the higher risk of periprocedural ipsilateral ischemic events, it is therefore recommended that the symptomatic patients should receive more careful treatment during the CAS placement going forward. Korea. Tel. 82-63-250-2582 Fax. 82-63-272-0481 E-mail: kwak8140@jbnu.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Index terms

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“…Several investigators, using DWI to detect clinically silent embolic lesions after protected CAS, have reported new DWI lesions at frequencies of 6.7-73 % [8,[17][18][19][20][21]. A substudy of the International Carotid Stenting Study (ICSS) reported that new DWI lesions occurred in 62 of 124 patients (50 %) in the stenting group [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Pitavastatin on Preventing Ischemic Complications with Carotid Artery Stenting: A Multicenter Prospective Study—EPOCH-CAS Study

Takayama

Taki

Toma

et al. 2013

Cardiovasc Intervent Radiol

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Purpose Periprocedural ischemic stroke is one problem associated with carotid artery stenting (CAS). This study was designed to assess whether preoperative statin therapy reduces the risk of periprocedural ischemic complications with CAS. Methods In this prospective study at 11 centers, patients with carotid artery stenosis (symptomatic C50 %, asymptomatic C80 %) and a high risk of carotid endarterectomy but without previous statin treatments were divided into two groups by low-density lipoprotein cholesterol (LDL-C) levels. With LDL-C C120 mg/dl, the pitavastatin-treated (PS) group received pitavastatin at 4 mg/day. With LDL-C \120 mg/dl, the non-PS group received no statin therapy. After 4 weeks, both groups underwent CAS. Frequencies of new ipsilateral ischemic lesions on diffusion-weighted imaging within 72 h after CAS and cerebrovascular events (transient ischemic attack, stroke, or death) within 30 days were assessed. Results Among the 80 patients enrolled, 61 patients (PS group, n = 31; non-PS group, n = 30) fulfilled the inclusion criteria. New ipsilateral ischemic lesions were identified in 8 of 31 patients (25.8 %) in the PS group and 16 of 30 patients (53.3 %) in the non-PS group (P = 0.028). Cerebrovascular events occurred in 0 patients in the PS group and in 3 of 30 patients (10.0 %) in the non-PS group (P = 0.071). Multivariate analyses demonstrated the pitavastatin treatment (b = 0.74, 95 % confidence interval 0.070-1.48, P = 0.042) to be an independent factor for decreasing post-CAS ischemic lesions.This study was conducted on behalf of the EPOCH-CAS Investigators. The members of EPOCH-CAS Investigators are given in Appendix. 123Cardiovasc Intervent Radiol (2014) 37:1436-1443 DOI 10.1007 Conclusion Pretreatment with pitavastatin significantly reduced the frequency of periprocedural ischemic complications with CAS.

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New Brain Lesions After Carotid Stenting Versus Carotid Endarterectomy

Cited by 279 publications

References 62 publications

New Ischemic Brain Lesions on Diffusion-Weighted MRI after Carotid Artery Stenting with Filter Protection: Frequency and Relationship with Plaque Morphology

New Ischemic Brain Lesions on Diffusion-Weighted MRI after Carotid Artery Stenting with Filter Protection: Frequency and Relationship with Plaque Morphology

The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

Effect of Pitavastatin on Preventing Ischemic Complications with Carotid Artery Stenting: A Multicenter Prospective Study—EPOCH-CAS Study

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