Ces radiol. 2025, 79(2):117-124 | DOI: 10.55095/CesRadiol2025/017

Risk factors for new ischaemic lesions on MR DWI after carotid stenting in patients with efficient antiplatelet therapyOriginal article

Pavol Vigláš^{1, 2}, Jan Raupach^{2, 3}, Aleš Hejčl⁴, David Černík⁵, Patrik Matras^{1, 6}, Karel Hrach⁷, Filip Cihlář¹

¹ Radiologická klinika Fakulty zdravotnických studií UJEP a Krajské zdravotní a.s. - Masarykovy nemocnice v Ústí nad Labem, o.z.

² Lékařská fakulta UK, Hradec Králové

³ Radiologická klinika LF UK a FN, Hradec Králové

⁴ Neurochirurgická klinika Fakulty zdravotnických studií UJEP a Krajské zdravotní a.s. -Masarykovy nemocnice v Ústí nad Labem, o.z.

⁵ Neurologické oddělení, Krajská zdravotní a.s. - Masarykova nemocnice v Ústí nad Labem, o.z.

⁶ 1. lékařská fakulta UK, Praha

⁷ Ústav biomedicíny a laboratorní diagnostiky FZS UJEP a Krajské zdravotní, a.s. - Masarykovy nemocnice v Ústí nad Labem, o.z. Korespondenční adresa:

Aim: To analyse the number, location and clinical significance of new ischaemic lesions after carotid stenting in patients with laboratory-confirmed effective antiplatelet therapy. To evaluate factors leading to thromboembolic complications and silent ischaemia.

Methods: We used a retrospective analysis to evaluate a cohort of 171 patients undergoing carotid stenting at the Radiology Department of Masaryk Hospital in Ústí nad Labem between 2014 and 2023. Magnetic resonance imaging with diffusion-weighted images was performed before and after stenting. We evaluated new ischemic lesions after the procedure and their dependence on patient demographics, nature of stenosis, instrumentation used, and antiplatelet therapy.

Results: New ischemic lesions were postprocedurally evident in 15.4% of patients (27/171). We recorded five ischemic strokes (2.9%), three of which were of the "minor stroke" type (1.7%) and two of the "major stroke" type (1.1%). Most ischemic lesions were located in the ipsilateral middle cerebral artery basin (87.9%), but they also occurred contralaterally or in another basin. Stenosis length ≥ 15 mm (p = 0.012) and higher degree of stenosis (p = 0.046) were shown to be statistically significantly associated with the development of new ischemic lesions. There was no dependence of the incidence of new ischemic lesions on age (p = 0.511) and stent type (p = 0.574).

Conclusion: In a cohort of patients with laboratory-proven effective antiplatelet therapy, new ischemic lesions after carotid stenting are significantly associated with the length and higher degree of stenosis, and are not dependent on the instrumentation used or the demographic characteristics of the cohort.

Keywords: carotid stenting, new ischemic lesions, antiplatelet therapy.

Accepted: March 4, 2025; Published: June 6, 2025  Show citation