Importance of brain MRI to evaluate immediate intracranial complications after carotid stenting in patients with significant carotid stenosis

Juan Ramon y Cajal-Calvo, Department of Neuroradiology, Hospital Clínico Universitario Lozano Blesa, Aragón Zaragoza, Spain
José A. Guirola-Ortiz, Department of Interventional Radiology, Hospital Clínico Universitario Lozano Blesa, Aragón Zaragoza, Spain
Maria J. Gimeño-Peribañez, Department of Neuroradiology, Hospital Clínico Universitario Lozano Blesa, Aragón Zaragoza, Spain
Carlos Tejero-Juste, Department of Neurology, Hospital Clínico Universitario Lozano Blesa, Aragón Zaragoza, Spain
Miguel A. de Gregorio-Ariza, Department of Interventional Radiology, Hospital Clínica Quirón Salud, Aragón Zaragoza, Spain

Objective: This prospective study aimed to fill the current knowledge gap in the literature by identifying the demographic and clinical characteristics of patients with carotid stenosis who undergo carotid arterial stenting. Methods: A cohort of 49 patients who underwent carotid artery stenting (CAS) from January 2021 to August 2022 was analyzed. Demographic information and data related to the existence of adverse neurological events were collected. Results: Stent placement achieved a 93.8% success rate when measured using the NASCET measurement criteria. Post-CAS neuroimaging revealed multifocal diffusion-weighted imaging (DWI) restriction in 8.16% of patients, hypointensity on susceptibility-weighted imaging in 8.16%, and focal DWI restriction in 32.65%, with no clinically significant deficits observed. A statistically significant association (p = 0.015) between severe stenosis and multifocal neuroimaging events was observed. Conclusions: Neurological complications observed by neuroimaging after CAS were not an indicator of an increased risk of clinically important adverse events at follow-up.

Keywords: Carotid stenosis. Self expandable metallic stents. Magnetic resonance spectroscopy. Radiology. Interventional.