THE INCIDENCE OF THE ISCHEMIC BRAIN MICROLESIONS AFTER CAROTID ARTERY STENTING

Aim. To estimate incidence of periprocedural ischemic brain microlesions after carotid artery stenting (CAS) and to identify most probable predictors. Material and methods. 84 patients with carotid artery stenosis undergoing carotid angioplasty with stenting (CAS) in a specialized medical center, between 2013 and 2016, were examined. All patients had diffusion-weighted magnetic resonance imaging before and after treatment for the detection of new periprocedural ischemic brain microlesions. Statistical analysis was performed using non-parametric methods.

Results. Among the selected patients aged 40 to 83 years (mean age of 60.6±3.9 years) there were 68 men (80.95%) and 16 women (19.05%). 39 (46.4%) of 84 patients had new ischemic brain microlesions after CAS both ipsilateral (37.8%) and non-ipsilateral location. 17.95% of them (n=7) had the transient or persistent neurological symptoms and the rest patients were asymptomatic. Patients with ischemic brain microlesions compared with patients without them were older and had lower hemoglobin level before CAS, history of previous strokes and as well as perioperative arterial hypotension persisting up to 24 hours (p<0.05). Statistically significant differences in atherosclerotic plaques characteristics and CAS technical features were not detected.

Conclusion. Ischemic brain microlesions after CAS, mostly asymptomatic, were detected in about half of patients. Microlesion appearance may be associated with older age, preprocedural lower hemoglobin level, previous strokes and periprocedural hemodynamic instability.

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