title: Ischemic cerebral lesions after carotid surgery and carotid stenting.
abstract: OBJECTIVE
  To evaluate the risk of new ischemic cerebral lesions after carotid endarterectomy and carotid stenting and their clinical significance.
  
  
  METHODS
  Prospective and non-randomized single-center study including 121 patients with symptomatic and asymptomatic significant carotid stenosis. 60 patients were treated by surgery and 61 treated by carotid stenting. Stenting was restricted to patients at high risk for surgery. Neurological examination and Diffusion-Weighted Cerebral Magnetic Resonance (DW-MRI) were performed before and after each procedure. The presence, location and volume of new cerebral lesions were determined.
  
  
  RESULTS
  In the surgical group, 2 minor strokes were registered. DW-MRI showed new lesions in 7 patients (11.6%). All except one were located in the ipsilateral anterior circulation. In the stenting group, 1 minor stroke and 1 occurrence of quadranopsia were registered. DW-MRI showed new lesions in 26 patients (42.6%). 10 of these patients (38.4%) had lesions in the contralateral hemisphere and 7 patients (26.9%) in the posterior circulation. Deficits are found in patients with higher lesion volumes.
  
  
  CONCLUSIONS
  Cerebral ischemic lesions are significantly (p<0.0001) more frequent after carotid stenting than after endarterectomy. The majority of these lesions have no immediate clinical implication, but more specific tests are needed to evaluate their exact significance.
authors.affiliation: Cliniques Universitaires Saint-Luc, Service de Chirurgie Cardiovasculaire et Thoracique, Bruxelles, Belgium. valerie.lacroix@clin.ucl.ac.be
authors.forename: V
authors.initials: V
authors.lastname: Lacroix
authors.forename: F
authors.initials: F
authors.lastname: Hammer
authors.forename: P
authors.initials: P
authors.lastname: Astarci
authors.forename: T
authors.initials: T
authors.lastname: Duprez
authors.forename: C
authors.initials: C
authors.lastname: Grandin
authors.forename: G
authors.initials: G
authors.lastname: Cosnard
authors.forename: A
authors.initials: A
authors.lastname: Peeters
authors.forename: R
authors.initials: R
authors.lastname: Verhelst
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000379:methods; D002545:Brain Ischemia / Q000150:complications / Q000209:etiology* / Q000473:pathology; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002544:Cerebral Infarction / Q000150:complications / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D015607:Stents; D020521:Stroke / Q000209:etiology* / Q000473:pathology; D016896:Treatment Outcome