title: Predictors of periprocedural brain lesions associated with carotid stenting.
abstract: BACKGROUND
  Carotid stenting carries a risk of periprocedural stroke. We aimed at determining predictors of cerebral ischemic events associated with stenting for symptomatic carotid stenosis.
  
  
  METHODS
  127 patients who had been studied by diffusion-weighted MR imaging (DWI) before and on the day after carotid stenting were included. Six clinical variables and 5 variables characterizing the target carotid artery and aortic atherosclerosis were analyzed as potential risk factors for new ipsilateral DWI lesions after stenting.
  
  
  RESULTS
  Among all variables assessed, only age, length of stenosis and carotid intima-media thickness (IMT) significantly modified the risk of new lesions after stenting. Age ≥68 years, stenosis ≥15 mm and IMT ≥1.3 mm were identified as the best thresholds to predict new lesions. In the subgroup of patients ≥68 years with carotid stenosis ≥15 mm in length and IMT ≥1.3 mm, the risk of new lesions was markedly higher than in patients to whom no more than two of these factors applied (odds ratio 7.250, 95% CI 1.612-34.513, p = 0.005). The use of this simple predictive model correctly identified patients who had new lesions after stenting with high specificity (0.96) and a negative predictive value (0.83), while the positive predictive value was moderate (0.60) and sensitivity was low (0.23).
  
  
  CONCLUSIONS
  The risk of stenting for symptomatic carotid stenosis may vary with clinical and morphological patient characteristics. Further research is needed to validate these results and to evaluate the safety of stenting versus endarterectomy in specific patient subgroups.
authors: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Arkadiusz
authors: A
authors: Russjan
authors: Einar
authors: E
authors: Goebell
authors: Stefanie
authors: S
authors: Havemeister
authors: Götz
authors: G
authors: Thomalla
authors: Bastian
authors: B
authors: Cheng
authors: Christoph
authors: C
authors: Beck
authors: Anna
authors: A
authors: Krützelmann
authors: Jens
authors: J
authors: Fiehler
authors: Christian
authors: C
authors: Gerloff
authors: Michael
authors: M
authors: Rosenkranz
mesh_terms: D000367:Age Factors; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation*; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy*; D016009:Chi-Square Distribution; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005858:Germany; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome