Independent risk factors for new ischemic brain lesions on diffusion-weighted imaging after carotid artery stenting: A retrospective study.

Background

New ischemic brain lesions detected by diffusion-weighted imaging are common after carotid artery stenting, but factors independently associated with their occurrence remain incompletely defined.

Methods

This single-center retrospective study included 97 patients with ischemic stroke and moderate-to-severe atherosclerotic extracranial carotid artery stenosis, contributing 104 treated carotid arteries that underwent carotid artery stenting. Clinical characteristics, stenosis features, laboratory parameters, and imaging data were collected. Diffusion-weighted imaging was performed before and within 72 h after the procedure. Treated arteries were classified into NIBL and non-NIBL groups. Univariate analysis was followed by multivariable logistic regression to identify factors independently associated with post-CAS NIBLs.

Results

A total of 97 patients with 104 treated carotid arteries were included, of which 68 (65.38%) were associated with new ischemic brain lesions within 72 h after CAS. Univariate analysis identified several associated factors, including coronary heart disease, HDL-C, abnormal total cholesterol, serum albumin, antithrombin III, fibrinogen degradation products, and heart rate-related parameters. Multivariable logistic regression identified coronary heart disease, HDL-C, abnormal total cholesterol, and perioperative heart rate change as factors independently associated with NIBLs. These factors were summarized as the "3C-H" combination.

Conclusion

New ischemic brain lesions were frequently detected after carotid artery stenting. Coronary heart disease, HDL-C, abnormal total cholesterol, and perioperative heart rate change were independently associated with post-CAS NIBLs. Further prospective studies are needed to validate these findings.