Ischemic cerebral lesions after carotid surgery and carotid stenting

Objectives. To evaluate the risk of new ischemic cerebral lesions after carotid endarterectomy and carotid stenting and their clinical significance. Methods. Prospective and non-randomized single-center study including 121 patients with symptomatic and asymptomatic significant carotid stenosis. 60 patients were treated by surgery and 61 treated by carotid stenting. Stenting was restricted to patients at high risk for surgery. Neurological examination and Diffusion-Weighted Cerebral Magnetic Resonance (DW-MRI) were performed before and after each procedure. The presence, location and volume of new cerebral lesions were determined. Results. In the surgical group, 2 minor strokes were registered. DW-MRI showed new lesions in 7 patients (11.6%). All except one were located in the ipsilateral anterior circulation. In the stenting group, 1 minor stroke and 1 occurrence of quadranopsia were registered. DW-MRI showed new lesions in 26 patients (42.6%). 10 of these patients (38.4%) had lesions in the contralateral hemisphere and 7 patients (26.9%) in the posterior circulation. Deficits are found in patients with higher lesion volumes. Conclusions. Cerebral ischemic lesions are significantly (p < 0.0001) more frequent after carotid stenting than after endarterectomy. The majority of these lesions have no immediate clinical implication, but more specific tests are needed to evaluate their exact significance.