Journal
STROKE
Volume 45, Issue 2, Pages 591-594Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.113.003605
Keywords
carotid stenosis; diffusion-weighted imaging; endarterectomy; intracranial embolism; stenting; stroke
Categories
Funding
- Medical Research Council
- Stroke Association
- Sanofi-Synthelabo
- European Union
- Mach-Gaensslen Foundation, Switzerland
- Dutch Heart Foundation
- Stroke Association, United Kingdom
- Swiss National Science Foundation [PBBSB-116873]
- University of Basel
- Reta Lila Weston Trust for Medical Research
- Department of Health's National Institute for Health Research Biomedical Research Centre
- Dutch Heart Foundation [2010T075]
- MRC [G0300411] Funding Source: UKRI
- Medical Research Council [G0300411] Funding Source: researchfish
- National Institute for Health Research [PB-PG-0609-19216, NF-SI-0507-10339] Funding Source: researchfish
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Background and Purpose We investigated predictors for acute and persisting periprocedural ischemic brain lesions among patients with symptomatic carotid stenosis randomized to stenting or endarterectomy in the International Carotid Stenting Study. Methods We assessed acute lesions on diffusion-weighted imaging 1 to 3 days after treatment in 124 stenting and 107 endarterectomy patients and lesions persisting on fluid-attenuated inversion recovery after 1 month in 86 and 75 patients, respectively. Results Stenting patients had more acute (relative risk, 8.8; 95% confidence interval, 4.4-17.5; P<0.001) and persisting lesions (relative risk, 4.2; 95% confidence interval, 1.6-11.1; P=0.005) than endarterectomy patients. Acute lesion count was associated with age (by trend), male sex, and stroke as the qualifying event in stenting; high systolic blood pressure in endarterectomy; and white matter disease in both groups. The rate of conversion from acute to persisting lesions was lower in the stenting group (relative risk, 0.4; 95% confidence interval, 0.2-0.8; P=0.007), and was only predicted by acute lesion volume. Conclusions Stenting caused more acute and persisting ischemic brain lesions than endarterectomy. However, the rate of conversion from acute to persisting lesions was lower in the stenting group, most likely attributable to lower acute lesion volumes. Clinical Trial Registration URL: www.isrctn.org. Unique identifier: ISRCTN25337470.
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