Asymptomatic Cerebral Emboli Following Carotid Artery Stenting: A Diffusion-Weighted MRI Study

BACKGROUND: Silent cranial embolism due to carotid artery stenting has been demonstrated to cause dementia, cognitive decline, and even ischemic stroke. The purpose of this study was to compare the periprocedural asymptomatic cranial embolism rates of different stent designs used for extracranial carotid stenosis with diffusion-weighted magnetic resonance imaging. METHODS: A total of 507 consecutive patients who underwent carotid artery stenting at our center from December 2010 to June 2020 (mean age, 66.4 ± 9.5) were analyzed retrospectively. The patients were divided into 3 groups as open-cell stent (334 patients), closed-cell stent (102 patients), and hybrid-cell stent (71 patients) groups. Diffusion-weighted magnetic resonance imaging was performed for the patients before and after carotid artery stenting and compared. The diffusion limitations of 3 stent groups on cranial diffusion-weighted magnetic resonance imaging were compared with one another. RESULTS: Periprocedural asymptomatic same-side microembolism, which was the primary endpoint of our study, was detected in 58 (17.4%) patients in the open-cell stent group, 6 (5.9%) patients in the closed-cell group, and 8 (11.3%) patients in the hybrid cell group, and overall in 72 (14.2%) patients. On diffusion-weighted magnetic resonance imaging, periprocedural asymptomatic same-side cranial embolism was found to be statistically significantly higher in the open-cell group compared to the other two groups (P = .011). CONCLUSIONS: The result of this study showed us that the rate of same-side cranial embolism detected on cranial diffusion-weighted magnetic resonance imaging after carotid artery stenting performed with open-cell stent was higher than those of the carotid artery stenting procedure performed with closed-cell and hybrid-cell stents.