New brain lesions at MR imaging after carotid angioplasty and stent placement.
OBJECTIVE
To assess, with magnetic resonance (MR) imaging, the number and size of new brain lesions after carotid angioplasty and stent placement (CAS) and to evaluate the association of these new lesions with neurologic deficits and transcranial Doppler ultrasonographic (US) data.


METHODS
Seventy-two consecutive CAS procedures were performed in 72 patients. Patients underwent neurologic examination before, during, immediately after, and 1 day, 3 months, and 1 year after CAS. MR imaging was used before and after CAS to assess the number of symptomatic and silent new infarctions. Two radiologists reviewed all pre- and postintervention MR images. The radiologists were blinded to the clinical data.


RESULTS
Postprocedural MR images showed new lesions on the side of stent placement in 11 patients. In six patients, the new lesions were clinically silent. Two patients had a major stroke, one had a minor stroke, and two had transient ischemic attack. In patients who had had transient ischemic attack or stroke before CAS, the frequency of new lesions at postprocedural MR imaging was higher (23%) than in asymptomatic patients (12%); this difference was not statistically significant (P =.29). There was no statistically significant correlation between embolic load as detected with transcranial Doppler US monitoring and the occurrence of either clinical symptoms or new lesions seen at MR imaging.


CONCLUSIONS
CAS is associated with embolic events. The majority of new lesions seen on postintervention MR images are not detected at neurologic examination.
van Heesewijk
Hans P M
HP
Departments of Radiology, St Antonius Hospital, Koekoekslaan 1, Postbus 2500, 3430 EM Nieuwegein (Utrecht), The Netherlands. j.heesewijk@antonius.net
Vos
Jan Albert
JA
Louwerse
Elisabeth S
ES
Van Den Berg
Jos C
JC
Overtoom
Timotheus T C
TT
Ernst
Sjef M P G
SM
Mauser
Henk W
HW
Moll
Frans L
FL
Ackerstaff
Rob G A
RG
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D001921:Brain / Q000473:pathology*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000628:therapy*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D017585:Ultrasonography, Doppler, Transcranial