title: New cerebral ischemic lesions after carotid endarterectomy.
abstract: BACKGROUND
  We sought to investigate the incidence and location of new cerebral ischemic lesions after carotid endarterectomy (CEA) using diffusion-weighted magnetic resonance imaging (DW-MRI).
  
  
  METHODS
  Sixty-six consecutive patients (50 males with a mean [±SD] age of 69 ± 9 years) who underwent CEA were included in this prospective study. Seventeen patients were symptomatic and 49 patients were asymptomatic. CEA was performed with patch closure without using a shunt. Carotid plaque echostructure was evaluated with the grayscale median (GSM) score. DW-MRI scanning of the brain was performed 24 hours before and 48 to 72 hours after the procedure.
  
  
  RESULTS
  Thirty-day stroke and mortality rates were 0%. The mean GSM score for symptomatic patients was 27 ± 15; for asymptomatic patients, the mean GSM score was 39 ± 18 (P = 0.006). Patients were divided into 2 groups according to GSM score: GSM scores ≤25 (22 patients) and GSM scores >26 (44 patients). New brain lesions were detected after 6 endarterectomies (8.9%), and all were clinically silent. These lesions were ischemic in 5 cases (7.5%) and micro-hemorrhagic in 1 case (1.4%). In 3 cases, new ischemic lesions were located within the treated carotid artery territory. In 2 cases, new lesions on DW-MRI were located outside of the treated carotid artery territory. There was no significant difference in the incidence of ischemic lesions between the 2 groups (GSM scores ≤25, 2 lesions; GSM scores >26, 3 lesions; P = 0.544).
  
  
  CONCLUSIONS
  New ischemic lesions on DW-MRI are detected in 7.5% of patients after CEA, and most of these lesions are clinically silent. Plaque echogenicity does not affect their incidence. New lesions seen on DW-MRI may be generated outside of the treated carotid artery territory.
authors.affiliation: Department of Vascular Surgery, Red Cross Hospital of Athens, Athens, Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Sfyroeras
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bessias
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Moulakakis
authors.forename: Stavroula
authors.initials: S
authors.lastname: Lyra
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kotsikoris
authors.forename: Vassilios
authors.initials: V
authors.lastname: Andrikopoulos
authors.forename: Christos D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome