New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS)
Summary Background The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI betw...
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| Veröffentlicht in: | Lancet neurology 2010-04, Vol.9 (4), p.353-362 |
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| creator | Bonati, Leo H, MD Jongen, Lisa M, MD Haller, Sven, MD Flach, H Zwenneke, MD Dobson, Joanna, MSc Nederkoorn, Paul J, MD Macdonald, Sumaira, FRCR Gaines, Peter A, FRCR Waaijer, Annet, MD Stierli, Peter, MD Jäger, H Rolf, FRCR Lyrer, Philippe A, MD Kappelle, L Jaap, MD Wetzel, Stephan G, MD van der Lugt, Aad, MD Mali, Willem P, MD Brown, Martin M, FRCP van der Worp, H Bart, MD Engelter, Stefan T, MD |
| description | Summary Background The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI between the two groups. Methods Patients with recently symptomatic carotid artery stenosis enrolled in ICSS were randomly assigned in a 1:1 ratio to receive carotid artery stenting or endarterectomy. Of 50 centres in ICSS, seven took part in the MRI substudy. The protocol specified that MRI was done 1–7 days before treatment, 1–3 days after treatment (post-treatment scan), and 27–33 days after treatment. Scans were analysed by two or three investigators who were masked to treatment. The primary endpoint was the presence of at least one new ischaemic brain lesion on diffusion-weighted imaging (DWI) on the post-treatment scan. Analysis was per protocol. This is a substudy of a registered trial, ISRCTN 25337470. Findings 231 patients (124 in the stenting group and 107 in the endarterectomy group) had MRI before and after treatment. 62 (50%) of 124 patients in the stenting group and 18 (17%) of 107 patients in the endarterectomy group had at least one new DWI lesion detected on post-treatment scans done a median of 1 day after treatment (adjusted odds ratio [OR] 5·21, 95% CI 2·78–9·79; p |
| doi_str_mv | 10.1016/S1474-4422(10)70057-0 |
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We aimed to compare the rate of ischaemic brain injury detectable on MRI between the two groups. Methods Patients with recently symptomatic carotid artery stenosis enrolled in ICSS were randomly assigned in a 1:1 ratio to receive carotid artery stenting or endarterectomy. Of 50 centres in ICSS, seven took part in the MRI substudy. The protocol specified that MRI was done 1–7 days before treatment, 1–3 days after treatment (post-treatment scan), and 27–33 days after treatment. Scans were analysed by two or three investigators who were masked to treatment. The primary endpoint was the presence of at least one new ischaemic brain lesion on diffusion-weighted imaging (DWI) on the post-treatment scan. Analysis was per protocol. This is a substudy of a registered trial, ISRCTN 25337470. Findings 231 patients (124 in the stenting group and 107 in the endarterectomy group) had MRI before and after treatment. 62 (50%) of 124 patients in the stenting group and 18 (17%) of 107 patients in the endarterectomy group had at least one new DWI lesion detected on post-treatment scans done a median of 1 day after treatment (adjusted odds ratio [OR] 5·21, 95% CI 2·78–9·79; p<0·0001). At 1 month, there were changes on fluid-attenuated inversion recovery sequences in 28 (33%) of 86 patients in the stenting group and six (8%) of 75 in the endarterectomy group (adjusted OR 5·93, 95% CI 2·25–15·62; p=0·0003). In patients treated at a centre with a policy of using cerebral protection devices, 37 (73%) of 51 in the stenting group and eight (17%) of 46 in the endarterectomy group had at least one new DWI lesion on post-treatment scans (adjusted OR 12·20, 95% CI 4·53–32·84), whereas in those treated at a centre with a policy of unprotected stenting, 25 (34%) of 73 patients in the stenting group and ten (16%) of 61 in the endarterectomy group had new lesions on DWI (adjusted OR 2·70, 1·16–6·24; interaction p=0·019). Interpretation About three times more patients in the stenting group than in the endarterectomy group had new ischaemic lesions on DWI on post-treatment scans. The difference in clinical stroke risk in ICSS is therefore unlikely to have been caused by ascertainment bias. Protection devices did not seem to be effective in preventing cerebral ischaemia during stenting. DWI might serve as a surrogate outcome measure in future trials of carotid interventions. Funding UK Medical Research Council, the Stroke Association, Sanofi-Synthélabo, European Union, Netherlands Heart Foundation, and Mach-Gaensslen Foundation.</description><identifier>ISSN: 1474-4422</identifier><identifier>EISSN: 1474-4465</identifier><identifier>DOI: 10.1016/S1474-4422(10)70057-0</identifier><identifier>PMID: 20189458</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Brain - pathology ; Brain - surgery ; Brain Ischemia - etiology ; Brain Ischemia - pathology ; Brain research ; Carotid arteries ; Carotid Stenosis - mortality ; Carotid Stenosis - pathology ; Carotid Stenosis - surgery ; Carotid Stenosis - therapy ; Diffusion Magnetic Resonance Imaging - methods ; Endarterectomy, Carotid - adverse effects ; Female ; Filtration - instrumentation ; Follow-Up Studies ; Humans ; Ischemia ; Male ; Neurology ; Odds Ratio ; Prospective Studies ; Stents - adverse effects ; Stroke ; Stroke - pathology ; Time Factors ; Treatment Outcome ; Veins & arteries</subject><ispartof>Lancet neurology, 2010-04, Vol.9 (4), p.353-362</ispartof><rights>Elsevier Ltd</rights><rights>2010 Elsevier Ltd</rights><rights>2010 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c611t-f11e7c0096697760da90a2d802ce9a055b0b81c9bd709ab5e9ad3b5a101c3eef3</citedby><cites>FETCH-LOGICAL-c611t-f11e7c0096697760da90a2d802ce9a055b0b81c9bd709ab5e9ad3b5a101c3eef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1474442210700570$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20189458$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bonati, Leo H, MD</creatorcontrib><creatorcontrib>Jongen, Lisa M, MD</creatorcontrib><creatorcontrib>Haller, Sven, MD</creatorcontrib><creatorcontrib>Flach, H Zwenneke, MD</creatorcontrib><creatorcontrib>Dobson, Joanna, MSc</creatorcontrib><creatorcontrib>Nederkoorn, Paul J, MD</creatorcontrib><creatorcontrib>Macdonald, Sumaira, FRCR</creatorcontrib><creatorcontrib>Gaines, Peter A, FRCR</creatorcontrib><creatorcontrib>Waaijer, Annet, MD</creatorcontrib><creatorcontrib>Stierli, Peter, MD</creatorcontrib><creatorcontrib>Jäger, H Rolf, FRCR</creatorcontrib><creatorcontrib>Lyrer, Philippe A, MD</creatorcontrib><creatorcontrib>Kappelle, L Jaap, MD</creatorcontrib><creatorcontrib>Wetzel, Stephan G, MD</creatorcontrib><creatorcontrib>van der Lugt, Aad, MD</creatorcontrib><creatorcontrib>Mali, Willem P, MD</creatorcontrib><creatorcontrib>Brown, Martin M, FRCP</creatorcontrib><creatorcontrib>van der Worp, H Bart, MD</creatorcontrib><creatorcontrib>Engelter, Stefan T, MD</creatorcontrib><creatorcontrib>for the ICSS-MRI study group</creatorcontrib><creatorcontrib>ICSS-MRI study group</creatorcontrib><title>New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS)</title><title>Lancet neurology</title><addtitle>Lancet Neurol</addtitle><description>Summary Background The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI between the two groups. Methods Patients with recently symptomatic carotid artery stenosis enrolled in ICSS were randomly assigned in a 1:1 ratio to receive carotid artery stenting or endarterectomy. Of 50 centres in ICSS, seven took part in the MRI substudy. The protocol specified that MRI was done 1–7 days before treatment, 1–3 days after treatment (post-treatment scan), and 27–33 days after treatment. Scans were analysed by two or three investigators who were masked to treatment. The primary endpoint was the presence of at least one new ischaemic brain lesion on diffusion-weighted imaging (DWI) on the post-treatment scan. Analysis was per protocol. This is a substudy of a registered trial, ISRCTN 25337470. Findings 231 patients (124 in the stenting group and 107 in the endarterectomy group) had MRI before and after treatment. 62 (50%) of 124 patients in the stenting group and 18 (17%) of 107 patients in the endarterectomy group had at least one new DWI lesion detected on post-treatment scans done a median of 1 day after treatment (adjusted odds ratio [OR] 5·21, 95% CI 2·78–9·79; p<0·0001). At 1 month, there were changes on fluid-attenuated inversion recovery sequences in 28 (33%) of 86 patients in the stenting group and six (8%) of 75 in the endarterectomy group (adjusted OR 5·93, 95% CI 2·25–15·62; p=0·0003). In patients treated at a centre with a policy of using cerebral protection devices, 37 (73%) of 51 in the stenting group and eight (17%) of 46 in the endarterectomy group had at least one new DWI lesion on post-treatment scans (adjusted OR 12·20, 95% CI 4·53–32·84), whereas in those treated at a centre with a policy of unprotected stenting, 25 (34%) of 73 patients in the stenting group and ten (16%) of 61 in the endarterectomy group had new lesions on DWI (adjusted OR 2·70, 1·16–6·24; interaction p=0·019). Interpretation About three times more patients in the stenting group than in the endarterectomy group had new ischaemic lesions on DWI on post-treatment scans. The difference in clinical stroke risk in ICSS is therefore unlikely to have been caused by ascertainment bias. Protection devices did not seem to be effective in preventing cerebral ischaemia during stenting. DWI might serve as a surrogate outcome measure in future trials of carotid interventions. Funding UK Medical Research Council, the Stroke Association, Sanofi-Synthélabo, European Union, Netherlands Heart Foundation, and Mach-Gaensslen Foundation.</description><subject>Aged</subject><subject>Brain - pathology</subject><subject>Brain - surgery</subject><subject>Brain Ischemia - etiology</subject><subject>Brain Ischemia - pathology</subject><subject>Brain research</subject><subject>Carotid arteries</subject><subject>Carotid Stenosis - mortality</subject><subject>Carotid Stenosis - pathology</subject><subject>Carotid Stenosis - surgery</subject><subject>Carotid Stenosis - therapy</subject><subject>Diffusion Magnetic Resonance Imaging - methods</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Female</subject><subject>Filtration - instrumentation</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Male</subject><subject>Neurology</subject><subject>Odds Ratio</subject><subject>Prospective Studies</subject><subject>Stents - adverse effects</subject><subject>Stroke</subject><subject>Stroke - pathology</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><issn>1474-4422</issn><issn>1474-4465</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkc1u1DAUhSMEoqXwCCCLDe0icJ3_dAFCI35GKiARWFuOc0NdEnvwdUB5Hl4UJzOdRTesbB-d-135nCh6yuElB168anhWZnGWJck5h4sSIC9juBedHuQiv3-8J8lJ9IjoBiDhWcUfRicJ8KrO8uo0-vsZ_zBN6lriqBVrndSGDUjaGmLWsE9ft0z2Hh0jj8Zr84NZx9B00gURlbfjzPog0TzuwkP6QFHSWa-7dcSSpksmGU0t-ambme2Zv0a2NWHeBLs1cmCbw0Rzu6RZvefbTdNcPI4e9HIgfHI4z6Lv799923yMr7582G7eXsWq4NzHPedYKoC6KOqyLKCTNcikqyBRWEvI8xbaiqu67UqoZZsHsUvbXIY4VYrYp2fRiz135-yvCcmLMSSDwyAN2olEmaYV1AAQnM_vOG_sFH4zkAjRZnXKoQqmfG9SzhI57MXO6VG6WXAQS4di7VAsBS3S2qFY4M8O8KkdsTtO3ZYWDG_2Bgxh_NboBCmNRmGnl0ZEZ_V_V7y-Q1CDNlrJ4SfOSMfPcEGJgD1kYXBYCZD-AzRiwmU</recordid><startdate>20100401</startdate><enddate>20100401</enddate><creator>Bonati, Leo H, MD</creator><creator>Jongen, Lisa M, MD</creator><creator>Haller, Sven, MD</creator><creator>Flach, H Zwenneke, MD</creator><creator>Dobson, Joanna, MSc</creator><creator>Nederkoorn, Paul J, MD</creator><creator>Macdonald, Sumaira, FRCR</creator><creator>Gaines, Peter A, FRCR</creator><creator>Waaijer, Annet, MD</creator><creator>Stierli, Peter, MD</creator><creator>Jäger, H Rolf, FRCR</creator><creator>Lyrer, Philippe A, MD</creator><creator>Kappelle, L Jaap, MD</creator><creator>Wetzel, Stephan G, MD</creator><creator>van der Lugt, Aad, MD</creator><creator>Mali, Willem P, MD</creator><creator>Brown, Martin M, FRCP</creator><creator>van der Worp, H Bart, MD</creator><creator>Engelter, Stefan T, MD</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8C2</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20100401</creationdate><title>New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS)</title><author>Bonati, Leo H, MD ; Jongen, Lisa M, MD ; Haller, Sven, MD ; Flach, H Zwenneke, MD ; Dobson, Joanna, MSc ; Nederkoorn, Paul J, MD ; Macdonald, Sumaira, FRCR ; Gaines, Peter A, FRCR ; Waaijer, Annet, MD ; Stierli, Peter, MD ; Jäger, H Rolf, FRCR ; Lyrer, Philippe A, MD ; Kappelle, L Jaap, MD ; Wetzel, Stephan G, MD ; van der Lugt, Aad, MD ; Mali, Willem P, MD ; Brown, Martin M, FRCP ; van der Worp, H Bart, MD ; Engelter, Stefan T, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c611t-f11e7c0096697760da90a2d802ce9a055b0b81c9bd709ab5e9ad3b5a101c3eef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Brain - pathology</topic><topic>Brain - surgery</topic><topic>Brain Ischemia - etiology</topic><topic>Brain Ischemia - pathology</topic><topic>Brain research</topic><topic>Carotid arteries</topic><topic>Carotid Stenosis - mortality</topic><topic>Carotid Stenosis - pathology</topic><topic>Carotid Stenosis - surgery</topic><topic>Carotid Stenosis - therapy</topic><topic>Diffusion Magnetic Resonance Imaging - methods</topic><topic>Endarterectomy, Carotid - adverse effects</topic><topic>Female</topic><topic>Filtration - instrumentation</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Male</topic><topic>Neurology</topic><topic>Odds Ratio</topic><topic>Prospective Studies</topic><topic>Stents - adverse effects</topic><topic>Stroke</topic><topic>Stroke - pathology</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bonati, Leo H, MD</creatorcontrib><creatorcontrib>Jongen, Lisa M, MD</creatorcontrib><creatorcontrib>Haller, Sven, MD</creatorcontrib><creatorcontrib>Flach, H Zwenneke, MD</creatorcontrib><creatorcontrib>Dobson, Joanna, MSc</creatorcontrib><creatorcontrib>Nederkoorn, Paul J, MD</creatorcontrib><creatorcontrib>Macdonald, Sumaira, FRCR</creatorcontrib><creatorcontrib>Gaines, Peter A, FRCR</creatorcontrib><creatorcontrib>Waaijer, Annet, MD</creatorcontrib><creatorcontrib>Stierli, Peter, MD</creatorcontrib><creatorcontrib>Jäger, H Rolf, FRCR</creatorcontrib><creatorcontrib>Lyrer, Philippe A, MD</creatorcontrib><creatorcontrib>Kappelle, L Jaap, MD</creatorcontrib><creatorcontrib>Wetzel, Stephan G, MD</creatorcontrib><creatorcontrib>van der Lugt, Aad, MD</creatorcontrib><creatorcontrib>Mali, Willem P, MD</creatorcontrib><creatorcontrib>Brown, Martin M, FRCP</creatorcontrib><creatorcontrib>van der Worp, H Bart, MD</creatorcontrib><creatorcontrib>Engelter, Stefan T, MD</creatorcontrib><creatorcontrib>for the ICSS-MRI study group</creatorcontrib><creatorcontrib>ICSS-MRI study group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Lancet Titles</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Lancet neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bonati, Leo H, MD</au><au>Jongen, Lisa M, MD</au><au>Haller, Sven, MD</au><au>Flach, H Zwenneke, MD</au><au>Dobson, Joanna, MSc</au><au>Nederkoorn, Paul J, MD</au><au>Macdonald, Sumaira, FRCR</au><au>Gaines, Peter A, FRCR</au><au>Waaijer, Annet, MD</au><au>Stierli, Peter, MD</au><au>Jäger, H Rolf, FRCR</au><au>Lyrer, Philippe A, MD</au><au>Kappelle, L Jaap, MD</au><au>Wetzel, Stephan G, MD</au><au>van der Lugt, Aad, MD</au><au>Mali, Willem P, MD</au><au>Brown, Martin M, FRCP</au><au>van der Worp, H Bart, MD</au><au>Engelter, Stefan T, MD</au><aucorp>for the ICSS-MRI study group</aucorp><aucorp>ICSS-MRI study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS)</atitle><jtitle>Lancet neurology</jtitle><addtitle>Lancet Neurol</addtitle><date>2010-04-01</date><risdate>2010</risdate><volume>9</volume><issue>4</issue><spage>353</spage><epage>362</epage><pages>353-362</pages><issn>1474-4422</issn><eissn>1474-4465</eissn><coden>LANCAO</coden><abstract>Summary Background The International Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI between the two groups. Methods Patients with recently symptomatic carotid artery stenosis enrolled in ICSS were randomly assigned in a 1:1 ratio to receive carotid artery stenting or endarterectomy. Of 50 centres in ICSS, seven took part in the MRI substudy. The protocol specified that MRI was done 1–7 days before treatment, 1–3 days after treatment (post-treatment scan), and 27–33 days after treatment. Scans were analysed by two or three investigators who were masked to treatment. The primary endpoint was the presence of at least one new ischaemic brain lesion on diffusion-weighted imaging (DWI) on the post-treatment scan. Analysis was per protocol. This is a substudy of a registered trial, ISRCTN 25337470. Findings 231 patients (124 in the stenting group and 107 in the endarterectomy group) had MRI before and after treatment. 62 (50%) of 124 patients in the stenting group and 18 (17%) of 107 patients in the endarterectomy group had at least one new DWI lesion detected on post-treatment scans done a median of 1 day after treatment (adjusted odds ratio [OR] 5·21, 95% CI 2·78–9·79; p<0·0001). At 1 month, there were changes on fluid-attenuated inversion recovery sequences in 28 (33%) of 86 patients in the stenting group and six (8%) of 75 in the endarterectomy group (adjusted OR 5·93, 95% CI 2·25–15·62; p=0·0003). In patients treated at a centre with a policy of using cerebral protection devices, 37 (73%) of 51 in the stenting group and eight (17%) of 46 in the endarterectomy group had at least one new DWI lesion on post-treatment scans (adjusted OR 12·20, 95% CI 4·53–32·84), whereas in those treated at a centre with a policy of unprotected stenting, 25 (34%) of 73 patients in the stenting group and ten (16%) of 61 in the endarterectomy group had new lesions on DWI (adjusted OR 2·70, 1·16–6·24; interaction p=0·019). Interpretation About three times more patients in the stenting group than in the endarterectomy group had new ischaemic lesions on DWI on post-treatment scans. The difference in clinical stroke risk in ICSS is therefore unlikely to have been caused by ascertainment bias. Protection devices did not seem to be effective in preventing cerebral ischaemia during stenting. DWI might serve as a surrogate outcome measure in future trials of carotid interventions. Funding UK Medical Research Council, the Stroke Association, Sanofi-Synthélabo, European Union, Netherlands Heart Foundation, and Mach-Gaensslen Foundation.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>20189458</pmid><doi>10.1016/S1474-4422(10)70057-0</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1474-4422 |
| ispartof | Lancet neurology, 2010-04, Vol.9 (4), p.353-362 |
| issn | 1474-4422 1474-4465 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_733809000 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Brain - pathology Brain - surgery Brain Ischemia - etiology Brain Ischemia - pathology Brain research Carotid arteries Carotid Stenosis - mortality Carotid Stenosis - pathology Carotid Stenosis - surgery Carotid Stenosis - therapy Diffusion Magnetic Resonance Imaging - methods Endarterectomy, Carotid - adverse effects Female Filtration - instrumentation Follow-Up Studies Humans Ischemia Male Neurology Odds Ratio Prospective Studies Stents - adverse effects Stroke Stroke - pathology Time Factors Treatment Outcome Veins & arteries |
| title | New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS) |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-30T16%3A02%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=New%20ischaemic%20brain%20lesions%20on%20MRI%20after%20stenting%20or%20endarterectomy%20for%20symptomatic%20carotid%20stenosis:%20a%20substudy%20of%20the%20International%20Carotid%20Stenting%20Study%20(ICSS)&rft.jtitle=Lancet%20neurology&rft.au=Bonati,%20Leo%20H,%20MD&rft.aucorp=for%20the%20ICSS-MRI%20study%20group&rft.date=2010-04-01&rft.volume=9&rft.issue=4&rft.spage=353&rft.epage=362&rft.pages=353-362&rft.issn=1474-4422&rft.eissn=1474-4465&rft.coden=LANCAO&rft_id=info:doi/10.1016/S1474-4422(10)70057-0&rft_dat=%3Cproquest_cross%3E733809000%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=201493108&rft_id=info:pmid/20189458&rft_els_id=S1474442210700570&rfr_iscdi=true |