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

• DOI: 10.1007/s00270-019-02173-1
• Publication Date: 2019-02-19T13:25:30Z
• Authors: M. A. Ruffino; R. Faletti; M. Fronda; M. Gatti; L. Bergamasco; L. Gibello; G. Varetto; D. Righi; P. Rispoli; P. Fonio
• Keywords: Male; Equipment Design; Surgical Mesh; Embolization, Therapeutic; 3. Good health; 03 medical and health sciences; Carotid Arteries; Diffusion Magnetic Resonance Imaging; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Intracranial Embolism; Humans; Carotid Stenosis; Female; Stents; Prospective Studies; Carotid stenting; Diffusion-weighted magnetic resonance; Internal carotid artery stenosis; Ischemic brain lesions; Micromesh stent; Aged; Carotid Arteries; Carotid Stenosis; Diffusion Magnetic Resonance Imaging; Embolization, Therapeutic; Equipment Design; Female; Humans; Intracranial Embolism; Male; Postoperative Complications; Prospective Studies; Stents; Surgical Mesh; Treatment Outcome; Aged

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