title: Contrast-enhanced ultrasound to predict the risk of microembolization during carotid artery stenting.
abstract: OBJECTIVE
  Cerebral microembolization, one of the most frequent complications of carotid artery stenting, is associated with an increased risk of peri- and post-procedural stroke and transient ischemic attack and a mid-term risk of neurocognitive decline. A valuable tool to evaluate carotid plaque instability and risk of embolization is contrast-enhanced ultrasound. With this prospective study we sought to determine the correlation between contrast enhancement of the plaque and cerebral microembolization after carotid stent deployment and to evaluate the clinical impact of the neurological injury.
  
  
  METHODS
  Thirty-five consecutive patients with carotid artery stenosis and indications for endovascular stenting were enrolled. Before the procedure, patients were evaluated with contrast-enhanced ultrasound to define plaque enhancement (signal intensity). All endovascular procedures were performed under cerebral filter protection. Diffusion-weighted magnetic resonance imaging scans to detect microemboli were obtained before and 48 h after the stent deployment. The Ray auditory verbal learning test to assess neurocognitive function was administered before and 1 month after the procedure.
  
  
  RESULTS
  Nineteen patients (54 %) developed new cerebral ischemic lesions after carotid artery stenting. Contrast enhancement of the plaque was greater in the patients with post-procedural microembolization than in those without it [maximum signal intensity 26 ± 7.7 vs. 21 ± 5.2, respectively, (p = 0.039), mean signal intensity, 20.7 ± 6.1 vs. 16.5 ± 5.3, respectively (p = 0.048)]. No correlation was found between neurocognitive test scores and microembolization or plaque enhancement.
  
  
  CONCLUSIONS
  Contrast enhancement of the carotid plaque is strongly associated with post-procedural microembolization and for this reason it can be considered a reliable tool for an accurate selection of patients undergoing this endovascular treatment. However, the neurocognitive test scores performed in this study are not enough sensible to appreciate the impact of the neurological injury on the day life activities.
authors: Division of Vascular Surgery, Department of Surgical Sciences, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, University of Turin, Molinette, Corso Bramante 88, 10126, Turin, Italy. gianfranco.varetto@unito.it.
authors: Gianfranco
authors: G
authors: Varetto
authors: Division of Vascular Surgery, Department of Surgical Sciences, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, University of Turin, Molinette, Corso Bramante 88, 10126, Turin, Italy.
authors: Lorenzo
authors: L
authors: Gibello
authors: Division of Radiology, Department of Surgical Sciences, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, University of Turin, Molinette, Corso Bramante 88, 10126, Turin, Italy. riccardo.faletti@gmail.com.
authors: Riccardo
authors: R
authors: Faletti
authors: Division of Vascular Surgery, Department of Surgical Sciences, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, University of Turin, Molinette, Corso Bramante 88, 10126, Turin, Italy.
authors: Andrea
authors: A
authors: Gattuso
authors: Division of Vascular Surgery, Department of Surgical Sciences, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, University of Turin, Molinette, Corso Bramante 88, 10126, Turin, Italy.
authors: Paolo
authors: P
authors: Garneri
authors: Division of Vascular Surgery, Department of Surgical Sciences, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, University of Turin, Molinette, Corso Bramante 88, 10126, Turin, Italy.
authors: Claudio
authors: C
authors: Castagno
authors: Division of Vascular Surgery, Department of Surgical Sciences, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, University of Turin, Molinette, Corso Bramante 88, 10126, Turin, Italy.
authors: Simone
authors: S
authors: Quaglino
authors: Division of Vascular Surgery, Department of Surgical Sciences, Azienda Ospedaliera Universitaria Città della Salute e delle Scienza, University of Turin, Molinette, Corso Bramante 88, 10126, Turin, Italy.
authors: Pietro
authors: P
authors: Rispoli
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D057505:Embolic Protection Devices; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000517:prevention & control; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D015607:Stents / Q000009:adverse effects*; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: CAS; CEUS; Carotid artery stenting; Contrast-enhanced ultrasound; Diffusion-weighted magnetic resonance imaging; Microembolization