title: Distal embolization after stenting of the vertebral artery: diffusion-weighted magnetic resonance imaging findings.
abstract: OBJECTIVE
  We retrospectively evaluated our experience with stenting of the vertebral artery in an effort to determine the risk of distal embolization associated with the procedure.
  
  
  METHODS
  Between June 2000 and May 2005, 35 patients with 38 stenting procedures for atherosclerotic disease of the vertebral origin in our institution were identified. The average age of the patients was 60.3 years (range 32-76 years). Sixteen of these patients (with 18 stents) had MR imaging of the brain with diffusion-weighted imaging and an apparent diffusion coefficient map within 2 days before and after procedure.
  
  
  RESULTS
  On seven of the 16 postprocedural diffusion-weighted MR images, a total of 57 new hyperintensities were visible. All these lesions were focal in nature. One patient demonstrated a new diffusion-weighted imaging abnormality in the anterior circulation without MR evidence of posterior circulation ischemia. Six of 16 patients had a total of 25 new lesions in the vertebrobasilar circulation in postprocedural diffusion-weighted MR images. One patient in this group was excluded from the final analysis because the procedure was complicated by basilar rupture during tandem stent deployment in the basilar artery. Hence, new diffusion-weighted imaging abnormalities were noted in the vertebrobasilar territory in 5 of 15 patients after 17 stenting procedures, giving a 29% rate of diffusion-weighted imaging abnormalities per procedure. No patient with bilateral stenting had new diffusion-weighted imaging abnormalities.
  
  
  CONCLUSIONS
  Stenting of stenoses of the vertebral artery origin may be associated with a significant risk of asymptomatic distal embolization. Angiography, placement of the guiding catheter, inflation of the stent balloon, and crossing the lesion with guidewires or balloon catheters may potentially cause distal embolization. Further studies to evaluate measures to increase the safety of vertebral artery stenting, such as the use of distal protection devices or short-term postprocedural anticoagulation, should be considered for patients with clear indications for this procedure.
authors.affiliation: Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100 Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Canyigit
authors.forename: Anil
authors.initials: A
authors.lastname: Arat
authors.forename: Barbaros E
authors.initials: BE
authors.lastname: Cil
authors.forename: Baris
authors.initials: B
authors.lastname: Turkbey
authors.forename: Isil
authors.initials: I
authors.lastname: Saatci
authors.forename: Saruhan
authors.initials: S
authors.lastname: Cekirge
authors.forename: Ferhun
authors.initials: F
authors.lastname: Balkanci
mesh_terms: D000328:Adult; D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D017211:Treatment Failure; D014421:Turkey; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery