当前位置： SCI文献检索 > JOURNAL OF VASCULAR SURGERY期刊下所有文献 > The distribution and size of ischemic lesions after carotid artery angioplasty and stenting: evidence for microembolization to terminal arteries.

The distribution and size of ischemic lesions after carotid artery angioplasty and stenting: evidence for microembolization to terminal arteries.

Abstract：

BACKGROUND:Much of the brain is perfused by penetrating arteries that are the "single source" of blood to their surrounding tissues. These tissues should be equally vulnerable to ischemia from embolic occlusion, but there are questions about whether emboli have access to the penetrating arteries serving the deep brain tissues. To examine this issue in humans we recorded the number and distribution of new ischemic lesions on diffusion-weighted magnetic resonance imaging (DWMRI) after carotid artery stenting (CAS), a procedure producing showers of numerous small atheroemboli. METHODS:Twenty-nine men (aged 62-81) underwent 30 CAS procedures with distal protection in place, and DWMRI 48 hours after the procedure documented new lesions had developed. Thirteen patients were asymptomatic, and 16 had experienced recent symptoms ipsilateral to the treated carotid stenosis. A DWMRI study was done in each patient ≤72 hours before the procedure. All MRI studies were read by the same neuroradiologist. RESULTS:One patient sustained a minor stroke, which resolved. DWNRI found 131 new lesions (median, 3; range, 1-17; interquartile range, 2-4). Lesion size was <5 mm in 96.6% and 5 to 10 mm in 3.1%. Lesions were ipsilateral in 83.1% and contralateral in 16.9%. Lesions were in the distribution of the middle cerebral artery (91.6%), posterior cerebral artery (6.1%), and superior cerebellar artery subclavian artery (2.0%). Most lesions were in the cortex but at a depth where they were best described as cortical/subcortical (90.8%). The rest were in the periventricular white matter (6.1%) and deep gray matter (3.0%). CONCLUSIONS:The ischemic areas developing after CAS were predominately in the deeper layers of the cortex in the distribution of the middle cerebral artery, but lesions were seen throughout the brain. The distribution of lesions caused by CAS-induced embolization coincided with estimates of blood flow to the respective areas of the brain. These data add to the evidence implicating microemboli in ischemic pathologies throughout the brain.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Zhu L,Wintermark M,Saloner D,Fandel M,Pan XM,Rapp JH

doi

10.1016/j.jvs.2010.10.091

subject

Has Abstract

pub_date

2011-04-01 00:00:00

pages

971-5; discussion 975-6

issue

eissn

0741-5214

issn

1097-6809

pii

S0741-5214(10)02482-1

journal_volume

pub_type

杂志文章

在线工具

The distribution and size of ischemic lesions after carotid artery angioplasty and stenting: evidence for microembolization to terminal arteries.