Early Diffusion-Weighted Imaging Lesions and Clinical Outcomes after Carotid Artery Stenting in Symptomatic Patients: A Single-Center Retrospective Study

PURPOSE: Carotid artery stenting (CAS) is an established alternative to carotid endarterectomy for selected patients with symptomatic carotid stenosis. Although predictors of periprocedural ischemic lesions detected on diffusion-weighted imaging (DWI) have been described, the relationship between these lesions and long-term functional outcomes remains incompletely understood. This study aimed to identify factors associated with early ischemic lesions after CAS and to evaluate whether these lesions are associated with 1-year clinical outcomes. MATERIALS AND METHODS: We retrospectively analyzed 190 patients who underwent CAS for symptomatic carotid artery stenosis at a single tertiary center. The primary outcome was the occurrence of new ischemic lesions on DWI within 24 hours after CAS. Secondary outcomes included periprocedural ischemic or hemorrhagic complications, recurrent ischemic cerebrovascular events within 1-year, restenosis at 1-year, and functional outcome at 1-year assessed by the modified Rankin Scale (mRS). Univariable and multivariable logistic regression analyses were performed to identify predictors of early embolic lesions and good functional outcome (mRS 0-2). RESULTS: New ischemic lesions on DWI were identified in 52 patients (27.4%). In multivariable analysis, atrial fibrillation was independently associated with early ischemic lesions (odds ratio, 4.747; 95% confidence interval, 1.133-19.888; P=0.033), whereas lesion severity and procedural factors were not. Periprocedural ischemic stroke with neurological deterioration occurred in 2.1% of patients, and symptomatic intracranial hemorrhage occurred in 1.1%. Good functional outcome (mRS 0-2) at 1-year was achieved in 82.1% of patients. New ischemic lesions were not independently associated with 1-year functional outcome, whereas baseline neurological severity was the primary determinant. CONCLUSION: New ischemic lesions on DWI were frequently observed after CAS but were not associated with long-term functional outcome. CAS was associated with low periprocedural complication rates and favorable 1-year outcomes in symptomatic patients treated at an experienced center.