Predictors of Acute and Persisting Ischemic Brain Lesions in Patients Randomized to Carotid Stenting or Endarterectomy
Authors: Rostamzadeh Ayda , Zumbrunn Thomas , Jongen Lisa M. , Nederkoorn Paul J. , Macdonald Sumaira , Lyrer Philippe A. , Kappelle L. Jaap , Mali Willem P. Th. M. , Brown Martin M. , van der Worp H. Bart , Engelter Stefan T. , Bonati Leo H. ,   The following centers enrolled patients in the International Carotid Stenting Study (ICSS)-MRI Study (number of patients included per center):,   University Medical Centre, Utrecht, The Netherlands (129 patients):, de Borst G.J. , de Kort G.A.P. , Jongen L.M. , Kappelle L.J. , Lo T.H. , Mali W.P.Th.M. , Moll F.L. , van der Worp H.B. ,   University Hospital Basel, Switzerland (50 patients):, Bonati L.H. , Engelter S.T. , Fluri F. , Haller S. , Jacob A.L. , Kirsch E. , Lyrer P.A. , Radue E.-W. , Stierli P. , Wasner M. , Wetzel S.G. ,   Erasmus Medical Centre, Rotterdam, The Netherlands (33 patients):, Flach H.Z. , Hendriks J.M. , Koudstaal P.J. , Pattynama P.M.T. , van Dijk L.C. , van Sambeek M.R.H.M. , van der Lugt A. , van Urk H. , Verhagen H.J.M. ,   Newcastle Acute Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (8 patients):, Clarke M. , Davis M. , Dixit A.K. , Dorman P. , Dyker A. , Ford G. , Golkar A. , Jackson R. , Jayakrishnan V. , Lambert D. , Lees T. , Louw S. , Macdonald S. , Mendelow D. , Rodgers H. , Rose J. , Stansby G. , Wyatt M. ,   Academic Medical Centre, Amsterdam, The Netherlands (5 patients):, Koelemaij M.J.W. , Majoie C.B.L.M. , Nederkoorn P.J. , Reekers J.A.A. , Roos Y.B.W.E.M. ,   University College London Hospitals NHS Foundation Trust, London, United Kingdom (5 patients):, Adiseshiah M. , Bishop C. , Brew S. , Brookes J. , Brown M.M. , Jäger H.R. , Kitchen N. ,   Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom (1 patient):, Beard J. , Cleveland T. , Dodd D. , Gaines P.A. , Lonsdale R. , Nair R. , Nassef A. , Nawaz S. , Venables G. 
Published: December 2013

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.