Journal of Vascular Surgery
Volume 45, Issue 5 , Pages 867-874 , May 2007

Subclinical embolization after carotid artery stenting: New lesions on diffusion-weighted magnetic resonance imaging occur postprocedure

Presented at the Twenty-first Annual Meeting of the Western Vascular Society, Sept 16-19, 2006, La Jolla, Calif.

  • Joseph H. Rapp, MD

      Affiliations

    • Vascular Surgery Service, San Francisco VA Medical Center, San Francisco, CA
    • Division of Vascular Surgery, University of California San Francisco, San Francisco, CA
    • Corresponding Author InformationCorrespondence: Joseph H. Rapp, MD, Vascular Surgery Service, San Francisco Department of Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA
    • ,
  • Laura Wakil, BA

      Affiliations

    • School of Medicine, University of California, San Francisco, CA
    • ,
  • Rajiv Sawhney, MD

      Affiliations

    • Radiology Service, San Francisco VA Medical Center, San Francisco, CA
    • Department of Radiology, University of California, San Francisco, CA
    • ,
  • Xian Mang Pan, MD

      Affiliations

    • Vascular Surgery Service, San Francisco VA Medical Center, San Francisco, CA
    • Division of Vascular Surgery, University of California San Francisco, San Francisco, CA
    • ,
  • Midori A. Yenari, MD

      Affiliations

    • Neurology Service, San Francisco VA Medical Center and Department of Neurology, University of California, San Francisco, CA
    • ,
  • Christine Glastonbury, MD

      Affiliations

    • Radiology Service, San Francisco VA Medical Center, San Francisco, CA
    • Department of Radiology, University of California, San Francisco, CA
    • ,
  • Sheila Coogan, MD

      Affiliations

    • Vascular Surgery Service, Palo Alto VA Medical Center and the Division of Vascular Surgery, Stanford Medical Center, San Fransico, CA
    • ,
  • Max Wintermark, MD

      Affiliations

    • Radiology Service, San Francisco VA Medical Center, San Francisco, CA
    • Department of Radiology, University of California, San Francisco, CA

Received 16 September 2006 ,Accepted 20 December 2006.

References 

  1. Rapp JH, Pan XM, Yu B, Swanson RA, Higashida RT, Simpson P, et al. Cerebral ischemia and infarction from atheroemboli <100 micron in size. Stroke. 2003;34:1976–1980
  2. Coggia M, Goeau-Brissonniere O, Duval JL, Lischi JP, Letort M, Nagel MD. Embolic risk of the different stages of carotid bifurcation balloon angioplasty: an experimental study. J Vasc Surg. 2000;31:550–557
  3. Rosenkranz M, Fiehler J, Niesen W, Waiblinger C, Eckert B, Wittkugel O, et al. The amount of solid cerebral microemboli during carotid stenting does not relate to the frequency of silent ischemic lesions. AJNR Am J Neuroradiol. 2006;27:157–161
  4. Rapp JH, Pan XM, Sharp FR, Shah DM, Wille GA, Velez PM, et al. Atheroemboli to the brain: Size threshold for causing acute neuronal cell death. J Vasc Surg. 2000;32:68–76
  5. Macdonald S. Is there any evidence that cerebral protection is beneficial: experimental data. J Cardiovasc Surg. 2006;47:127–136
  6. Chen C, Iguchi Y, Garami Z, Malkoff M, Smalling R, Campbell M, et al. Analysis of emboli during carotid stenting with distal protection device. Cerebrovasc Dis. 2006;21:223–228
  7. Pinero P, Gonzalez A, Mayol A, Martinez E, Gonsalez-Marcos JR, Boza F, et al. Silent ischemia after neuroprotected percutaneous carotid stenting: a diffusion-weighted study. Am J Neuroradiol. 2006;27:1338–1345
  8. Terada TTT, Tsuura M, Matsumoto H, Masuo O, Yamaga H, Itakura T. Diffusion-weighted imaging abnormalities after percutaneous transluminal angioplasty and stenting for intracranial atherosclerotic disease. Am J Neuroradiol. 2005;26:385–389
  9. Hauth EA, Jansen C, Drescher R, Schwartz M, Forsting M, Jaeger HJ, et al. MR and clinical follow-up of diffusion-weighted cerebral lesions after carotid artery stenting. Am J Neuroradiol. 2005;26:2336–2341
  10. Kastrup A, Nagele T, Groschel K, Schnidt F, Vogler E, Schulz J, et al. Incidence of new brain lesions after carotid stenting with and without cerebral protection. Stroke. 2006;37:2312–2316
  11. du Mesnil de Rochemont R, Schneider S, Yan B, Lehr A, Sitzer M, et al. Diffusion-weighted MR imaging lesions after filter-protected stenting of high-grade symptomatic carotid artery stenoses. Am J Neuroradiol. 2006;27:1321–1325
  12. Markus HS, Clifton A, Bickenham T, Brown MM. Carotid angioplasty: detection of embolic signals during and after the procedure. Stroke. 1994;25:2403–2406
  13. Moseley ME, Mintorovitch H, Cohen Y, Asgari HS, Derugin N, Norman D, et al. Early detection of ischemic injury: comparison of spectroscopy, diffusion-, T2-, and magnetic susceptibility-weighted MRI in cats. Acta Neutochir Suppl. 1990;51:207–209
  14. Yoneda Y, Tokui D, Hanihara T, Kitagaki H, Tabuchi M, Mori E. Diffusion-weighted magnetic resonance imaging: detection of eschemic injury 39 minutes after onset in a stroke patient. Ann Neurol. 1999;45:794–797
  15. Hammer FD, Lacroix V, Duprez T, Grandin C, Verheist R, Peeters A, et al. Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2 year prospective study. J Vasc Surg. 2005;42:847-33
  16. Feiwell RJ, Besmertis L, Sardar R, Saloner DA, Rapp JH. Detection of clinically silent infarcts after carotid endarterectomy by use of diffusion-weighted imaging. Am J Neuroradiol. 2001;22:646–649
  17. Forbes KP, Shill HA, Britt PM, Zabramski HM, Spetzler RF, Heiserman HE. Assessment of silent embolism from carotid endarterectomy by use of diffusion-weighted imaging. Am J Neuroradiol. 2001;22:650–653
  18. Roh HG, Byun HS, Ryoo JW, Na DG, Moon WJ, Lee BB, et al. Prospective analysis of cerebral infarction after carotid endarterectomy and carotid artery stent placement by using diffusion-weighted imaging. Am J Neuroradiol. 2005;26:376–384
  19. Purandare N, Burns A, Daly KJ, Hardicre J, Morris J, Macfarlane G, et al. Cerebral emboli as a potential cause of Alzheimer’s disease and vascular dementia: case-control study. BMJ. 2006;332:1119–1124

 Competition of interest: none.CME article

PII: S0741-5214(07)00007-9

doi: 10.1016/j.jvs.2006.12.058

Journal of Vascular Surgery
Volume 45, Issue 5 , Pages 867-874 , May 2007

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