Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1859
Peer-review started: December 30, 2019
First decision: February 20, 2020
Revised: March 26, 2020
Accepted: April 21, 2020
Article in press: April 21, 2020
Published online: May 26, 2020
Carotid artery stenting (CAS) is a relatively less-invasive method in high grade carotid artery stenosis. New symptomatic or asymptomatic cerebral ischemia lesions can develop due to CAS. Diffusion-weighted imaging (DWI) can be used to determine the number and volume of new ischemic lesions. In the present study, cerebral locations, vascular distribution areas and volumes of ischemic lesions that developed due to CAS were evaluated using DWI.
The frequency and size of new ischemias that can develop due to CAS in cases with carotid artery stenosis can be determined using DWI, and thus precautions can be taken against complications that might arise during the follow-up period.
Cerebral locations, vascular distributions and volumes of new ischemic lesions that developed due to CAS were investigated. In addition, associations between stenosis rate, morphology of the plaque causing the stenosis and new lesion development were studied.
The study included 64 cases that underwent CAS procedures at Tokat Gaziosmanpasa University, Faculty of Medicine, Department of Radiology, between October 2006 and July 2012. Demographic data, average stenosis rate, accompanying comorbid diseases and their frequencies and distribution of atherosclerotic plaque morphology of patients who had DSA due to CAS were evaluated. DWI images after CAS were evaluated retrospectively by two experienced neuroradiologists in a comparative manner. The number of new lesions and their volumes were determined. Associations between the number of new lesions and the side of the stenosis and those between gender and plaque morphologies were studied.
Thirty-nine new lesions were observed in 20 of 64 cases (31.2%) with CAS. The lesions were ipsilateral in 17 cases (26.5%) and contralateral in 3 cases (4.6%). The average volume of the new ischemic lesions was determined as 1.10 cm³ by two observers. The most common locations for the new ischemic lesions were occipital and frontal lobes. In terms of watershed areas, they were common in middle cerebral artery and posterior cerebral artery territories. Silent ischemias were found in 15 cases (23.4%) after CAS procedures, while 5 cases (7.8%) had symptomatic ischemias.
New CAS-originated ischemic lesions are predominantly observed in main arterial territories, but they may also be seen in watershed areas. The higher number of ischemic lesions located on the left side could be explained by the difficulty of accessing the left common carotid artery, the higher number of attempts and longer intervention time. Despite lower stenosis rates, ischemic lesions can be more frequent in ulcerated plaques.
The number, size and localizations of new lesions that can develop due to CAS can be determined through DWI. Thus, arising symptoms can be determined and managed effectively.