"The results from our analysis do not support the role of ischemic brain lesions discovered on DWI after carotid revascularization procedures as risk markers for long-term recurrent stroke or transient ischemic attack," wrote a research team led by Simone Donners, MD, of University Medical Center Utrecht in the Netherlands.
Carotid artery revascularization can result in new ischemic brain lesions on diffusion-weighted magnetic resonance imaging, the team noted.
The group sought to assess any links between periprocedural ischemic DWI lesions that appeared in a cohort of 162 patients with symptomatic carotid stenosis after carotid artery revascularization and long-term cerebrovascular events such as stroke. The patients had participated in the ICSS (International Carotid Stenting Study) and were randomized to carotid artery stenting or carotid endarterectomy groups; all underwent MR imaging one to seven days before and one to three days after treatment.
The study's primary endpoint was incidence of stroke or transient ischemic attack during follow-up (median time, 8.6 years; range, 5 to 12.5 years), the team noted. The authors compared patients who showed new DWI lesions on post-treatment MRI exams to those who did not.
The team found that incidence of new lesions on MRI exam follow-up was not significant.
Comparison of stroke incidence among patients without and with new lesions on DWI-MRI at 12.5-year follow-up |
Event |
Patients without new lesions on DWI-MRI |
Patients with new lesions on DWI-MRI |
Incidence of stroke or transient ischemic attack |
Kaplan-Meier cumulative incidence |
31.1% |
35.3% |
Uni- and multivariable regression analyses (hazard ratio, with 1 as reference) |
1.3 |
1.5 |
"Based on our outcome analysis within the International Carotid Stenting Study MRI substudy, DWI lesions following carotid revascularization did not seem to have a relationship with long-term stroke risk," the investigators concluded.
The complete study can be found here.
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