title: Reduced cerebrovascular reserve is associated with an increased risk of postoperative ischemic lesions during carotid artery stenting.
abstract: BACKGROUND
  Reduced cerebrovascular reserve (CVR) is associated with increased risk of ischemic events in carotid steno-occlusive diseases.
  
  
  OBJECTIVE
  To determine whether pretreatment CVR can predict postoperative ischemic lesions after carotid artery stenting (CAS) by retrospective analysis.
  
  
  METHODS
  We retrospectively reviewed the medical records of 46 patients (42 men; mean age 74.2±8.3 years) who underwent CAS and preprocedural cerebral blood flow measurement by quantitative single-photon emission CT. Ischemic lesions were evaluated by diffusion-weighted image (DWI) within 72 h after the intervention. We also evaluated plaque characteristics using black-blood MR plaque imaging.
  
  
  RESULTS
  New ipsilateral DWI-positive lesions were found in 11 cases (23.9%). Patients were classified into two groups based on the presence or absence of new DWI-positive lesions, and no significant differences in characteristics were found between the DWI-positive and DWI-negative groups, except for age and CVR of the ipsilateral middle cerebral artery (MCA) territory. The DWI-positive group was significantly older than the DWI-negative group (79.7±4.1 vs 72.5±8.6 years; p=0.0085) and had lower average regional CVR (1.4±18.2% vs 22.4±25.8%; p=0.016). MR plaque imaging showed no significant difference in relative overall plaque MR signal intensity between the two groups (1.53±0.37 vs 1.34±0.26; p=0.113). In multivariate logistic regression analysis, lower CVR of the ipsilateral MCA territory (<11%) was the only independent risk factor for new ischemic lesions following CAS (OR=6.99; 95% CI 1.17 to 41.80; p=0.033).
  
  
  CONCLUSIONS
  Impaired pretreatment CVR was associated with increased incidence of new infarction after CAS.
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-City, Japan Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Koyanagi
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-City, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kurosaki
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-City, Japan.
authors.forename: Nobutake
authors.initials: N
authors.lastname: Sadamasa
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-City, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Narumi
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-City, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-City, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Chin
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-City, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Handa
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki-City, Japan.
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D020520:Brain Infarction / Q000209:etiology / Q000503:physiopathology; D002545:Brain Ischemia / Q000209:etiology* / Q000503:physiopathology; D002339:Carotid Arteries / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Atherosclerosis; Stent; Stroke