title: Associations between Cerebral Embolism and Carotid Intraplaque Hemorrhage during Protected Carotid Artery Stenting.
abstract: OBJECTIVE
  Carotid artery stent placement in patients with intraplaque hemorrhage remains controversial because of the incidence of cerebral embolism after the procedure. The purpose of this study is to determine if intraplaque hemorrhage is a significant risk factor for cerebral embolism during carotid artery stent placement.
  
  
  METHODS
  This prospective study assessed 94 consecutive patients with severe carotid stenosis. These patients underwent preprocedural carotid MR imaging and postprocedural DWI after carotid artery stent placement. Intraplaque hemorrhage was defined as the presence of high signal intensity within the carotid plaque that was >200% of the signal from the adjacent muscle on MPRAGE. We then analyzed the incidence of postprocedural ipsilateral ischemic events on DWI and primary outcomes within 30 days of carotid artery stent placement.
  
  
  RESULTS
  Forty-three patients (45.7%) had intraplaque hemorrhage on an MPRAGE image. There was no significant difference in the incidence of postprocedural ipsilateral ischemic events and primary outcomes between the intraplaque hemorrhage and non-intraplaque hemorrhage group. However, postprocedural ipsilateral ischemic events were more frequently observed in the symptomatic group (17/41 [41.5%]) than in the asymptomatic group (8/53 [15.1%]; P = .005).
  
  
  CONCLUSIONS
  Intraplaque hemorrhage was not a significant risk factor for cerebral embolism during carotid artery stent placement in patients with severe carotid stenosis. Symptomatic patients should receive more careful treatment during carotid artery stent placement because of the higher risk of postprocedural ipsilateral ischemic events.
authors.affiliation: From the Radiology and Research Institute, Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeollabuk-do, Republic of Korea.
authors.forename: G H
authors.identifier: http://orcid.org/0000-0002-6757-8208
authors.initials: GH
authors.lastname: Chung
authors.affiliation: From the Radiology and Research Institute, Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeollabuk-do, Republic of Korea.
authors.forename: J Y
authors.identifier: http://orcid.org/0000-0003-1507-7222
authors.initials: JY
authors.lastname: Jeong
authors.affiliation: From the Radiology and Research Institute, Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeollabuk-do, Republic of Korea. kwak8140@jbnu.ac.kr.
authors.forename: H S
authors.identifier: http://orcid.org/0000-0002-7228-8117
authors.initials: HS
authors.lastname: Kwak
authors.affiliation: From the Radiology and Research Institute, Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeollabuk-do, Republic of Korea.
authors.forename: S B
authors.identifier: http://orcid.org/0000-0002-2420-3182
authors.initials: SB
authors.lastname: Hwang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020766:Intracranial Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome