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New Brain Lesions at MR Imaging after Carotid Angioplasty and Stent Placement¹

¹ From the Departments of Radiology (H.P.M.v.H., J.A.V., T.T.C.O., J.C.v.d.B.), Clinical Neurophysiology (E.S.L., R.G.A.A.), Cardiology (S.M.P.G.E.), Neurology (H.W.M.), and Vascular Surgery (F.L.M.), St Antonius Hospital, Koekoekslaan 1, Postbus 2500, 3430 EM Nieuwegein (Utrecht), the Netherlands. Received July 31, 2001; revision requested September 24; revision received November 21; accepted January 8, 2002. Address correspondence to H.P.M.v.H. (e-mail: j.heesewijk@antonius.net).

PURPOSE: To assess, with magnetic resonance (MR) imaging, the number and size of new brain lesions after carotid angioplasty and stent placement (CAS) and to evaluate the association of these new lesions with neurologic deficits and transcranial Doppler ultrasonographic (US) data.

MATERIALS AND METHODS: Seventy-two consecutive CAS procedures were performed in 72 patients. Patients underwent neurologic examination before, during, immediately after, and 1 day, 3 months, and 1 year after CAS. MR imaging was used before and after CAS to assess the number of symptomatic and silent new infarctions. Two radiologists reviewed all pre- and postintervention MR images. The radiologists were blinded to the clinical data.

RESULTS: Postprocedural MR images showed new lesions on the side of stent placement in 11 patients. In six patients, the new lesions were clinically silent. Two patients had a major stroke, one had a minor stroke, and two had transient ischemic attack. In patients who had had transient ischemic attack or stroke before CAS, the frequency of new lesions at postprocedural MR imaging was higher (23%) than in asymptomatic patients (12%); this difference was not statistically significant (P = .29). There was no statistically significant correlation between embolic load as detected with transcranial Doppler US monitoring and the occurrence of either clinical symptoms or new lesions seen at MR imaging.

CONCLUSION: CAS is associated with embolic events. The majority of new lesions seen on postintervention MR images are not detected at neurologic examination.

© RSNA, 2002

Index terms: Carotid arteries, MR, 1722.121411, 178.121411 • Carotid arteries, stenosis or obstruction, 1722.721, 178.721 • Carotid arteries, transluminal angioplasty, 1722.1269, 178.1269 • Carotid arteries, US, 1722.12989, 178.12989

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