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Predictors of Acute and Persisting Ischemic Brain Lesions in Patients Randomized to Carotid Stenting or Endarterectomy

Lookup NU author(s): Dr Sumaira MacDonald


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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: Unique identifier: ISRCTN25337470.

Publication metadata

Author(s): Rostamzadeh A, Zumbrunn T, Jongen LM, Nederkoorn PJ, Macdonald S, Lyrer PA, Kappelle LJ, Mali WPTM, Brown MM, van der Worp HB, Engelter ST, Bonati LH

Publication type: Article

Publication status: Published

Journal: Stroke

Year: 2014

Volume: 45

Issue: 2

Pages: 591-594

Print publication date: 24/12/2013

ISSN (print): 0039-2499

ISSN (electronic): 1524-4628

Publisher: Lippincott Williams & Wilkins


DOI: 10.1161/STROKEAHA.113.003605


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Funder referenceFunder name
Dutch Heart Foundation
Medical Research Council
Stroke Association
Stroke Association, United Kingdom
University of Basel
Department of Health's National Institute for Health Research Biomedical Research Centre
European Union
Mach-Gaensslen Foundation, Switzerland
Reta Lila Weston Trust for Medical Research
2010T075Dutch Heart Foundation
PBBSB-116873Swiss National Science Foundation