title: The Role of White Matter Damage in the Risk of Periprocedural Diffusion-Weighted Lesions after Carotid Artery Stenting.
abstract: BACKGROUND
  White matter hyperintensities (WMH) are a common finding in aged individuals affected by carotid artery disease and are a risk factor for first-ever and recurrent stroke. We investigated if white matter damage increases the risk of brain microembolism during carotid artery stenting (CAS), as evaluated by the appearance of new areas of restricted diffusion on diffusion-weighted images (DWI).
  
  
  METHODS
  We evaluated 47 patients with severe internal carotid artery (ICA) stenosis undergoing CAS, comparing preprocedural clinical, ultrasound and radiological characteristics. WMH volume was computed on FLAIR images before CAS. After CAS, the DWI scan was looked over for areas of restricted diffusion (DWI lesions). A first univariate analysis was adopted to compare groups according to the occurrence of DWI lesions. Then, the variable DWI lesion was modelled by means of a logistic regression model.
  
  
  RESULTS
  Seventeen patients developed at least 1 DWI lesion after CAS. Compared with non-DWI, DWI patients were more commonly treated in the left ICA (p = 0.007) and had a more severe WMH damage (p = 0.027). Indeed, the risk of a DWI lesion was higher in left versus right stenosis (OR = 9.0, 95% CI 1.9-42.7, p = 0.005) and increased for each log-unit of WMH lesion load (OR = 7.05, 95% CI 1.07-46.49, p = 0.042). A WMH lesion load of at least 5.25 cm3 had a 50% probability of occurrence of a new DWI lesion.
  
  
  CONCLUSIONS
  Treated side and preexisting white matter damage are risk conditions for brain microembolism during CAS. This should be taken into account to optimize severe carotid artery disease management.
authors.affiliation: Neurology Unit, ASST Bergamo Est, Azienda Ospedaliera Bolognini, Seriate, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Maggio
authors.forename: Claudia
authors.initials: C
authors.lastname: Altamura
authors.forename: Domenico
authors.initials: D
authors.lastname: Lupoi
authors.forename: Matteo
authors.initials: M
authors.lastname: Paolucci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Altavilla
authors.forename: Francesco
authors.initials: F
authors.lastname: Tibuzzi
authors.forename: Francesco
authors.initials: F
authors.lastname: Passarelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Arpesani
authors.forename: Guido
authors.initials: G
authors.lastname: Di Giambattista
authors.forename: Rosario Francesco
authors.initials: RF
authors.lastname: Grasso
authors.forename: Giacomo
authors.initials: G
authors.lastname: Luppi
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fiacco
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvestrini
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pasqualetti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Vernieri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016009:Chi-Square Distribution; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D007558:Italy; D056784:Leukoencephalopathies / Q000000981:diagnostic imaging* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: Carotid artery stenting; Diffusion-weighted images; White matter hyperintensities