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Kastrup A., Gröschel K., Schnaudigel S.
Department of Neurology University of Göttingen, Göttingen, Germany
Carotid angioplasty and stenting (CAS) is currently being evaluated as an alternative treatment modality to carotid endarterectomy (CEA) in patients with severe carotid artery stenosis. At present, diffusion-weighted MR-imaging (DWI) is the most sensitive tool to detect early cerebral ischemia and offers the possibility of visualizing even small embolic lesions shortly after their emergence. Thus, DWI is increasingly being used as a surrogate marker of thromboembolic events after either CEA or CAS. The purpose of this article is to discuss the potential application of DWI in patients undergoing CAS in the context of the literature and own works within this field. To date, 19 studies have used DWI to determine the occurrence of cerebral ischemia after CAS and found new lesions in 9% to 64% of the patients. The majority of these lesions were clinically asymptomatic and of less than 10 mm in diameter. So far, the reported values of the incidence of new DWI lesions after CAS vary greatly and most likely reflect differences in patient characteristics, experience of the interventionalist, sensitivity of the DWI techniques in detecting small lesions, as well as in the time-point of imaging after CAS. Another variable may be the differential usage of cerebral protection devices in particular because evidence is accumulating that the use of cerebral protection devices potentially reduces the number of new ipsilateral DWI lesions after CAS. Although it is beyond doubt that DWI is a useful quality assessment tool, which is also able to improve the safety of CAS, further research is needed to clarify the impact of new DWI lesions on brain structures as well as cognitive brain functions.