Cerebral ischemia detected with diffusion-weighted MR imaging after stent implantation in the carotid artery.
OBJECTIVE
Concern regarding the safety of stent implantation in the carotid artery exists because of the risk of cerebral embolization during the procedure. The purpose of this prospective study was to determine the incidence of new areas of cerebral ischemia, as detected by using diffusion-weighted MR imaging after stent implantation in the carotid artery.


METHODS
Diffusion-weighted MR imaging of the brain was performed in 67 patients with 70 high-grade stenoses of the carotid artery before and 24 hours after stent implantation.


RESULTS
The neurologic status of the patients was unchanged after 69 of 70 procedures. During one procedure, symptomatic cerebral embolization occurred. Diffusion-weighted MR images showed new ipsilateral lesions after stent implantation in 20 patients (29%), including the symptomatic patient, and new contralateral lesions in six patients (9%). Fifty-two of 59 postprocedural lesions occurred in the vascular territory supplied by the treated vessel. The occurrence of new postprocedural ipsilateral lesions was not significantly correlated with patient demographic data, characteristics of the stenoses, or details of the procedure.


CONCLUSIONS
In 29% of the procedures, stent implantation in the carotid artery was associated with new areas of cerebral ischemia, as detected by using diffusion-weighted MR images; these findings indicated the occurrence of cerebral microemboli during such procedures. In all patients except one, the new lesions were clinically silent.
Jaeger
Horst J
HJ
Department of Radiology, Staedtische Kliniken Dortmund, University of Witten/Herdecke, Germany.
Mathias
Klaus D
KD
Hauth
Elke
E
Drescher
Robert
R
Gissler
H Martin
HM
Hennigs
Svenja
S
Christmann
Andreas
A
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002339:Carotid Arteries / Q000473:pathology*; D002533:Cerebral Angiography; D004058:Diffusion; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*