title: Rapid formation of cerebral microbleeds after carotid artery stenting.
abstract: BACKGROUND
  Recent studies reported that cerebral microbleeds (CMBs), i.e. small areas of signal loss on T(2)*-weighted gradient-echo (GE) imaging, could develop rapidly after acute ischemic stroke. We hypothesized that CMBs rapidly emerge after carotid artery stenting (CAS).
  
  
  OBJECTIVE
  We investigated the frequency of and predisposing factors for CMBs after CAS.
  
  
  METHODS
  We retrospectively examined MRI before and after CAS in 88 consecutive patients (average age: 71.7 ± 7.2 years, average rates of carotid stenosis: 72.6 ± 12.8%) who underwent CAS for carotid artery stenosis between March 1, 2009, and September 30, 2010. We defined new CMBs as signal losses that newly appeared on the follow-up GE. We examined the association of new CMBs with demographics, risk factors, and baseline MBs.
  
  
  RESULTS
  Among 88 patients, 18 (20.5%) had CMBs initially, and 7 (8.0%) developed new CMBs right after CAS. New CMBs appeared on the same side of CAS in all of the 7 patients. New CMBs appeared significantly more frequently in the CMB-positive group than in the CMB-negative one (22% vs. 4%, p = 0.03) on the pre-CAS MRI. Multivariate analysis also revealed that the presence of CMBs before CAS was an independent predictor of new development of CMBs after CAS (odds ratio: 8.09, 95% confidence interval: 1.39-47.1).
  
  
  CONCLUSIONS
  CMBs can develop rapidly after CAS, especially in patients with pre-existing CMBs. Since the existence of CMBs prior to CAS suggests a latent vascular damage which is vulnerable to hemodynamic stress following CAS, particular attention should be paid to the prevention of intracerebral hemorrhage due to hyperperfusion after CAS.
authors.affiliation: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Kakumoto
authors.forename: Shoji
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakahara
authors.forename: Yoshihiko
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authors.lastname: Watanabe
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Fukushima
authors.forename: Urabe
authors.initials: U
authors.lastname: Yoshikiyo
authors.forename: Ryota
authors.initials: R
authors.lastname: Ishibashi
authors.forename: Masanori
authors.initials: M
authors.lastname: Gomi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tsuji
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Sanbongi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Kira