Ischemic Brain Lesions After Carotid Artery Stenting Increase Future Cerebrovascular Risk | Journal Scan

Study Questions:

What is the long-term outcome of patients who develop brain lesions on diffusion-weighted imaging (DWI) after carotid artery stenting (CAS)?


The authors randomized 231 patients with symptomatic carotid stenosis randomized to CAS (n = 124) or carotid endarterectomy (CEA) (n = 107). Magnetic resonance imaging (MRI) was performed 1-7 days before and 1-3 days after treatment. The primary outcome event was stroke or transient ischemic attack (TIA) in any territory occurring between the post-treatment MRI and 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.


Median time of follow-up was 4.1 years. There was no difference in recurrent cerebrovascular events between DWI+ and DWI- patients among patients undergoing CEA. In the CAS group, recurrent stroke or TIA occurred more often among DWI+ patients (12/62) than among DWI- patients (6/62), with cumulative 5-year incidences of 22.8% and 8.8%, respectively (unadjusted hazard ratio, 2.85; 95% confidence interval, 1.05-7.72; p = 0.04).


The authors concluded that ischemic brain lesions discovered on DWI following CAS appear to be a marker of increased risk for recurrent cerebrovascular events.


The clinical significance of this small study is unclear. A much larger body of data supports similar long-term outcomes with CAS and CEA. Also, the long-term incidence of neurological events in this study is much higher than has been observed in larger randomized trials, and extrapolation to other patient populations is difficult. While the study findings are intriguing, the results are at best considered hypothesis generating and invoke the need for further investigation.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Magnetic Resonance Imaging

Keywords: Carotid Arteries, Carotid Stenosis, Diffusion Magnetic Resonance Imaging, Endarterectomy, Carotid, Ischemic Attack, Transient, Stroke, Brain

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