Background: White matter hyperintensities (WMH) are a common finding in aged individuals affected by carotid artery disease and are a risk factor for first-ever and recurrent stroke. We investigated if white matter damage increases the risk of brain microembolism during carotid artery stenting (CAS), as evaluated by the appearance of new areas of restricted diffusion on diffusion-weighted images (DWI). Methods: We evaluated 47 patients with severe internal carotid artery (ICA) stenosis undergoing CAS, comparing preprocedural clinical, ultrasound and radiological characteristics. WMH volume was computed on FLAIR images before CAS. After CAS, the DWI scan was looked over for areas of restricted diffusion (DWI lesions). A first univariate analysis was adopted to compare groups according to the occurrence of DWI lesions. Then, the variable DWI lesion was modelled by means of a logistic regression model. Results: Seventeen patients developed at least 1 DWI lesion after CAS. Compared with non-DWI, DWI patients were more commonly treated in the left ICA (p = 0.007) and had a more severe WMH damage (p = 0.027). Indeed, the risk of a DWI lesion was higher in left versus right stenosis (OR = 9.0, 95% CI 1.9-42.7, p = 0.005) and increased for each log-unit of WMH lesion load (OR = 7.05, 95% CI 1.07-46.49, p = 0.042). A WMH lesion load of at least 5.25 cm3 had a 50% probability of occurrence of a new DWI lesion. Conclusions: Treated side and preexisting white matter damage are risk conditions for brain microembolism during CAS. This should be taken into account to optimize severe carotid artery disease management.

The Role of White Matter Damage in the Risk of Periprocedural Diffusion-Weighted Lesions after Carotid Artery Stenting / Maggio, P.; Altamura, C.; Lupoi, D.; Paolucci, M.; Altavilla, R.; Tibuzzi, F.; Passarelli, F.; Arpesani, R.; Di Giambattista, G.; Grasso, R. F.; Luppi, G.; Fiacco, F.; Silvestrini, M.; Pasqualetti, P.; Vernieri, F.. - In: CEREBROVASCULAR DISEASES. EXTRA. - ISSN 1664-5456. - 7:1(2017), pp. 1-8. [10.1159/000452717]

The Role of White Matter Damage in the Risk of Periprocedural Diffusion-Weighted Lesions after Carotid Artery Stenting

Di Giambattista G.;Silvestrini M.;Pasqualetti P.;
2017

Abstract

Background: White matter hyperintensities (WMH) are a common finding in aged individuals affected by carotid artery disease and are a risk factor for first-ever and recurrent stroke. We investigated if white matter damage increases the risk of brain microembolism during carotid artery stenting (CAS), as evaluated by the appearance of new areas of restricted diffusion on diffusion-weighted images (DWI). Methods: We evaluated 47 patients with severe internal carotid artery (ICA) stenosis undergoing CAS, comparing preprocedural clinical, ultrasound and radiological characteristics. WMH volume was computed on FLAIR images before CAS. After CAS, the DWI scan was looked over for areas of restricted diffusion (DWI lesions). A first univariate analysis was adopted to compare groups according to the occurrence of DWI lesions. Then, the variable DWI lesion was modelled by means of a logistic regression model. Results: Seventeen patients developed at least 1 DWI lesion after CAS. Compared with non-DWI, DWI patients were more commonly treated in the left ICA (p = 0.007) and had a more severe WMH damage (p = 0.027). Indeed, the risk of a DWI lesion was higher in left versus right stenosis (OR = 9.0, 95% CI 1.9-42.7, p = 0.005) and increased for each log-unit of WMH lesion load (OR = 7.05, 95% CI 1.07-46.49, p = 0.042). A WMH lesion load of at least 5.25 cm3 had a 50% probability of occurrence of a new DWI lesion. Conclusions: Treated side and preexisting white matter damage are risk conditions for brain microembolism during CAS. This should be taken into account to optimize severe carotid artery disease management.
2017
carotid artery stenting; diffusion-weighted images; white matter hyperintensities; aged; aged, 80 and over; angioplasty, balloon; carotid stenosis; chi-square distribution; female; humans; intracranial embolism; italy; leukoencephalopathies; logistic models; male; multivariate analysis; odds ratio; predictive value of tests; retrospective studies; riska assessment; risk factors; treatment outcome; diffusion magnetic resonance imaging; stents
01 Pubblicazione su rivista::01a Articolo in rivista
The Role of White Matter Damage in the Risk of Periprocedural Diffusion-Weighted Lesions after Carotid Artery Stenting / Maggio, P.; Altamura, C.; Lupoi, D.; Paolucci, M.; Altavilla, R.; Tibuzzi, F.; Passarelli, F.; Arpesani, R.; Di Giambattista, G.; Grasso, R. F.; Luppi, G.; Fiacco, F.; Silvestrini, M.; Pasqualetti, P.; Vernieri, F.. - In: CEREBROVASCULAR DISEASES. EXTRA. - ISSN 1664-5456. - 7:1(2017), pp. 1-8. [10.1159/000452717]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1578672
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