title: Characteristics of ischemic brain lesions after stenting or endarterectomy for symptomatic carotid artery stenosis: results from the international carotid stenting study-magnetic resonance imaging substudy.
abstract: OBJECTIVE
  In a substudy of the International Carotid Stenting Study (ICSS), more patients had new ischemic brain lesions on diffusion-weighted magnetic resonance imaging (MRI) after stenting (CAS) than after endarterectomy (CEA). In the present analysis, we compared characteristics of diffusion-weighted MRI lesions.
  
  
  METHODS
  Number, individual and total volumes, and location of new diffusion-weighted MRI lesions were compared in patients with symptomatic carotid stenosis randomized to CAS (n=124) or CEA (n=107) in the ICSS-MRI substudy.
  
  
  RESULTS
  CAS patients had higher lesion numbers than CEA patients (1 lesion, 15% vs 8%; 2-5 lesions, 19% vs 5%; >5 lesions, 16% vs 4%). The overall risk ratio for the expected lesion count with CAS versus CEA was 8.8 (95% confidence interval, 4.4-17.5; P<0.0001) and significantly increased among patients with lower blood pressure at randomization, diabetes mellitus, stroke as the qualifying event, left-side stenosis, and if patients were treated at centers routinely using filter-type protection devices during CAS. Individual lesions were smaller in the CAS group than in the CEA group (P<0.0001). Total lesion volume per patient did not differ significantly. Lesions in the CAS group were more likely to occur in cortical areas and subjacent white matter supplied by leptomeningeal arteries than lesions in the CEA group (odds ratio, 4.2; 95% confidence interval, 1.7-10.2; P=0.002).
  
  
  CONCLUSIONS
  Compared with patients undergoing CEA, patients treated with CAS had higher numbers of periprocedural ischemic brain lesions, and lesions were smaller and more likely to occur in cortical areas and subjacent white matter. These findings may reflect differences in underlying mechanisms of cerebral ischemia.
authors.affiliation: Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
authors.forename: Henrik
authors.initials: H
authors.lastname: Gensicke
authors.forename: Thomas
authors.initials: T
authors.lastname: Zumbrunn
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Jongen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.forename: Sumaira
authors.initials: S
authors.lastname: Macdonald
authors.forename: Peter A
authors.initials: PA
authors.lastname: Gaines
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Lyrer
authors.forename: Stephan G
authors.initials: SG
authors.lastname: Wetzel
authors.forename: Aad
authors.initials: A
authors.lastname: van der Lugt
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Martin M
authors.initials: MM
authors.lastname: Brown
authors.forename: H Bart
authors.initials: HB
authors.lastname: van der Worp
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bonati
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome