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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

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Objectives

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.

Methods

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.

Results

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 < 0.0001). This result was paralleled by the difference in ADC value (0.83 ± 0.21 vs. 1.42 ± 0.52).

Conclusion

The majority of early asymptomatic brain lesion occurred during the first 24 h after CAS. Pre-procedure high DWI signal of the plaque was associated with an increased incidence of post-procedure microembolizations.

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Abbreviations

CAS:

Carotid artery stenting

CEA:

Carotid endarterectomy

DUS:

Duplex ultrasound

MRI:

Magnetic resonance imaging

DWI:

Diffusion-weighted imaging

NIHSS:

National Institute of Health Stroke Scale

NASCET:

North American symptomatic carotid endarterectomy trial

ASA:

Acetylsalicylic acid

ADC:

Apparent diffusion coefficient

CT:

Computed tomography

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Authors and Affiliations

  1. Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, Città della Salute e della Scienza di Torino, Turin, Italy

    M. A. Ruffino & D. Righi

  2. Department of Surgical Sciences - Radiology Unit, University of Turin, Turin, Italy

    R. Faletti, M. Fronda, M. Gatti & P. Fonio

  3. Department of Surgical Sciences, Città della Salute e della Scienza di Torino, Turin, Italy

    L. Bergamasco

  4. Department of Surgical Sciences – Vascular Surgery, University of Torino, Turin, Italy

    L. Gibello, G. Varetto & P. Rispoli

Authors
  1. M. A. Ruffino
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  2. R. Faletti
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  3. M. Fronda
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  4. M. Gatti
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  5. L. Bergamasco
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  10. P. Fonio
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Corresponding author

Correspondence to M. Fronda.

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All authors have declared that they have no conflicts of interest.

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Patients’ information was anonymized prior to the analysis. The study was piloted in agreement with the 1964 Helsinki declaration and its later amendments and approved by the ethics committee of our institution.

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Ruffino, M.A., Faletti, R., Fronda, M. et al. 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. Cardiovasc Intervent Radiol 42, 812–819 (2019). https://doi.org/10.1007/s00270-019-02173-1

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