title: Evaluation of angiographic and technical aspects of carotid stenting with diffusion-weighted magnetic resonance imaging.
abstract: The detection of clinically silent ischemic lesions on postprocedural diffusion-weighted magnetic resonance images has become a preferred method for the description of embolic risks. The purpose of this single-center study was to evaluate whether diffusion-weighted imaging (DWI) could determine material related or technical risk factors of filter-protected carotid stenting. Eighty-four patients with symptomatic severe (> or = 60%) carotid artery stenoses received filter-protected carotid stenting. Standard DWI (b = 1000) was performed within 48 h before and after carotid stenting. The occurrence and load of new postinterventional DWI lesions were assessed. Multivariate analysis was performed to determine risk factors associated with DWI lesions, with emphasis on technical factors such as use of different access devices (guiding catheter method vs. long carotid sheath method), type of stent (open-cell nitinol stent vs. closed-cell Wallstent), and protective device (filters with 80-microm vs. 110-120-microm pore size). Markers for generalized atherosclerosis and for degree and site of stenosis were assessed to allow comparison of adequate risk profiles. Access, protective device, and stent type were not significantly associated with new embolic DWI lesions when we compared patients with equivalent risk profiles (long carotid sheath method 48% [11 of 23] vs. guiding catheter method 44% [27 of 61], Wallstent 47% [15 of 32] vs. nitinol stent 44% [23 of 52], and small pore size filter 61% [11 of 18] vs. large pore size filter 41% [27 of 66]). Single-center DWI studies with a moderate number of cases are inadequate for proper assessment of the embolic risk of technical- or material-related risk factors in carotid stenting. Larger multicenter studies with more cases are needed.
authors.affiliation: Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. Stella.Blasel@kgu.de
authors.forename: Stella
authors.initials: S
authors.lastname: Blasel
authors.forename: Elke
authors.initials: E
authors.lastname: Hattingen
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Wiebke
authors.initials: W
authors.lastname: Kurre
authors.forename: Gerald
authors.initials: G
authors.lastname: Morawe
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Zanella
authors.forename: Richard Du Mesnil
authors.initials: Rdu M
authors.lastname: de Rochemont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016009:Chi-Square Distribution; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography