Plaque morphology effect on periprocedural asymptomatic cerebral embolism in carotid artery stenting using first-generation carotid stents: A diffusion-weighted magnetic resonance imaging study

Silent cerebral embolism with carotid artery stenting (CAS) may contribute to dementia and cognitive decline. Moreover, clinically silent embolism is an important index of peri-procedural stroke risk. The purpose of this study was to compare the periprocedural asymptomatic cerebral embolism rates of CAS procedures performed for noncalcified and calcified carotid artery plaques using diffusion-weighted magnetic resonance imaging (DW-MRI). Five hundred and seventy clinically uncomplicated patients who underwent CAS at our center from December 2010 to June 2020 (mean [standard deviation, SD] age 69.3 [8.2 years]) were analyzed retrospectively. The patients were divided into 2 groups with noncalcified (268 patients) and calcified (302 patients) plague. Cerebral DW-MRI was performed for the patients before and after CAS and compared. The presence of periprocedural new ipsilateral diffusion limitations detected on cerebral DW-MRI was noted as a significant finding. Ipsilateral diffusion limitations of the non-calcified and calcified plaque groups detected on cerebral DW-MRI were compared. The presence of periprocedural asymptomatic ipsilateral DW-MRI lesions was higher in patients in the noncalcified plaque group (45 [16.8%]) than in patients in the calcified plaque group (31 [10.3%]; P = 0.02). This study demonstrated that the rate of ipsilateral asymptomatic cerebral embolism detected on cerebral DW-MRI was higher in the CAS procedures performed for noncalcified carotid artery plaques than in those performed for calcified plaques.