title: Predictors of acute and persisting ischemic brain lesions in patients randomized to carotid stenting or endarterectomy.
abstract: OBJECTIVE
  We investigated predictors for acute and persisting periprocedural ischemic brain lesions among patients with symptomatic carotid stenosis randomized to stenting or endarterectomy in the International Carotid Stenting Study.
  
  
  METHODS
  We assessed acute lesions on diffusion-weighted imaging 1 to 3 days after treatment in 124 stenting and 107 endarterectomy patients and lesions persisting on fluid-attenuated inversion recovery after 1 month in 86 and 75 patients, respectively.
  
  
  RESULTS
  Stenting patients had more acute (relative risk, 8.8; 95% confidence interval, 4.4-17.5; P<0.001) and persisting lesions (relative risk, 4.2; 95% confidence interval, 1.6-11.1; P=0.005) than endarterectomy patients. Acute lesion count was associated with age (by trend), male sex, and stroke as the qualifying event in stenting; high systolic blood pressure in endarterectomy; and white matter disease in both groups. The rate of conversion from acute to persisting lesions was lower in the stenting group (relative risk, 0.4; 95% confidence interval, 0.2-0.8; P=0.007), and was only predicted by acute lesion volume.
  
  
  CONCLUSIONS
  Stenting caused more acute and persisting ischemic brain lesions than endarterectomy. However, the rate of conversion from acute to persisting lesions was lower in the stenting group, most likely attributable to lower acute lesion volumes. Clinical Trial Registration -URL: www.isrctn.org. Unique identifier: ISRCTN25337470.
authors.affiliation: From the Department of Neurology and Stroke Unit (A.R., P.A.L., S.T.E., L.H.B.), Clinical Trial Unit (T.Z.), University Hospital Basel, Basel, Switzerland; Department of Radiology (L.M.J., W.P.Th.M.M.), Department of Neurology, Rudolf Magnus Institute of Neuroscience (L.J.K., H.B.v.d.W.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Neurology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands (P.J.N.); Department of Radiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (S.M.); and Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, Queen Square, London, United Kingdom (M.M.B., L.H.B.).
authors.forename: Ayda
authors.initials: A
authors.lastname: Rostamzadeh
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: Philippe A
authors.initials: PA
authors.lastname: Lyrer
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
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: D000208:Acute Disease; D002545:Brain Ischemia / Q000453:epidemiology*; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery; D016001:Confidence Intervals; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D007091:Image Processing, Computer-Assisted; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012727:Sex Characteristics; D015607:Stents / Q000706:statistics & numerical data*
keywords: carotid stenosis; diffusion-weighted imaging; endarterectomy; intracranial embolism; stenting; stroke