1. Early Embolization After Carotid Artery Stenting with Mesh-Covered Stent: Role of Diffusion-Weighted Magnetic Resonance Imaging as Pre-procedural Predictor and Discriminant Between Intra- and Post-procedural Events
- Author
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Paolo Fonio, Marco Fronda, Riccardo Faletti, Gianfranco Varetto, Marco Gatti, Maria Antonella Ruffino, Dorico Righi, Lorenzo Gibello, Pietro Rispoli, and Laura Bergamasco
- Subjects
Male ,medicine.medical_specialty ,Micromesh stent ,Internal carotid artery stenosis ,medicine.medical_treatment ,Asymptomatic ,030218 nuclear medicine & medical imaging ,Lesion ,Embolization ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Diffusion-weighted magnetic resonance ,Humans ,Medicine ,Effective diffusion coefficient ,Carotid Stenosis ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Carotid stenting ,Ischemic brain lesions ,Aged ,Carotid Arteries ,Diffusion Magnetic Resonance Imaging ,Embolization, Therapeutic ,Equipment Design ,Female ,Intracranial Embolism ,Stents ,Surgical Mesh ,Treatment Outcome ,Prospective cohort study ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Hyperintensity ,Stenosis ,Radiology ,Therapeutic ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
To evaluate the incidence and the time of onset of early micro-embolism after CAS (carotid artery stenting) with two different mesh-covered stents and to assess the role of DW-MRI (Diffusion-weighted magnetic resonance imaging) in their prediction. Single-institution prospective study including 50 patients (33 male, median age 74 years) who underwent CAS with Roadsaver® or CGuard™. All patients with primary stenosis (37/50, 74%) had carotid plaque DW-MRI pre-procedure, with both qualitative evaluation of the hyperintensity and ADC (apparent diffusion coefficient) measurement of the plaque. All patients had brain DW-MRI pre-procedure, at 1 h, 24 h and 30 days post-procedure to evaluate the appearance of hyperintense lesions over time. Imaging analysis was performed in a double-blinded fashion by two radiologists. There were no statistically significant differences between the two stents both in the incidence at 1 h (P = 0.23) and 24 h (P = 0.36) and in the volume of new DWI hyperintense brain lesions at 24 h (P = 0.27). Thirty-four new asymptomatic lesions in 19 patients (38%) were reported: 4 (11.8%) at 1 h, 30 (88.2%) at 24 h. The 30-day DWI-MR showed complete resolution of all lesions and no evidence of new lesion. The incidence of new lesions at 24 h resulted significantly higher in patients with DWI hyperintense carotid plaques (12/16, 75% vs. 0/21, 0%, P more...
- Published
- 2019
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