title: New ischemic brain lesions on diffusion-weighted MRI after carotid artery stenting with filter protection: frequency and relationship with plaque morphology.
abstract: OBJECTIVE
  CAS carries an inherent risk of distal cerebral embolization, precipitating new brain ischemic lesions and neurologic symptoms. Our purpose was to evaluate the frequency of new ischemic lesions found on DWI after protected CAS placement and to determine its association with plaque morphology.
  
  
  METHODS
  Fifty patients (mean age 65.13 ± 7.08 years) with moderate and severe internal carotid artery stenosis underwent CAS with distal filter protection. Fibrolipid and fibrocalcified plaque morphology was determined by sonography according to the relative contribution of echogenic and echolucent material, and by multisection CT using plaque attenuation. There were 46.81% of patients with fibrolipid and 53.19% with fibrocalcified plaques. DWI was performed before and 24 hours after CAS.
  
  
  RESULTS
  Seven (14.89%) patients showed new lesions. Four (8.51%) had 6 new lesions inside the treated vascular territory. Three had a single lesion and 1 patient had 3 lesions (mean: 1.5 ± 1). Most lesions (66.66%) were subcortical, with a mean diameter of 9 mm (range 5-15 mm). All lesions occurred in the area supplied by the middle cerebral artery and were clinically silent. A significant relationship was found between plaque morphology and the appearance of new lesions. Patients with fibrolipid plaques had a significantly higher number of new lesions compared with patients with fibrocalcified plaques (P = .041). The absolute risk of new lesions in the fibrolipid group was 18.18%.
  
  
  CONCLUSIONS
  New ischemic lesions were observed in the treated vascular territory in 8.51% of patients. The appearance of new ischemic lesions was significantly related to the plaque morphology. Fibrolipid plaques were associated with higher numbers of new lesions.
authors.affiliation: Institute of Radiology, Clinical Center Nis, Nis, Serbia.
authors.forename: D
authors.initials: D
authors.lastname: Stojanov
authors.forename: M
authors.initials: M
authors.lastname: Ilic
authors.forename: P
authors.initials: P
authors.lastname: Bosnjakovic
authors.forename: M
authors.initials: M
authors.lastname: Zivkovic
authors.forename: S
authors.initials: S
authors.lastname: Jolic
authors.forename: N
authors.initials: N
authors.lastname: Vukasinovic
authors.forename: A
authors.initials: A
authors.lastname: Ignjatovic
authors.forename: B
authors.initials: B
authors.lastname: Ilic
authors.forename: D
authors.initials: D
authors.lastname: Benedeto-Stojanov
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology* / Q000473:pathology* / Q000517:prevention & control; D016893:Carotid Stenosis / Q000453:epidemiology* / Q000601:surgery*; D015897:Comorbidity; D038524:Diffusion Magnetic Resonance Imaging / Q000706:statistics & numerical data; D057505:Embolic Protection Devices / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D055771:Serbia / Q000453:epidemiology; D015607:Stents / Q000706:statistics & numerical data*