Original title: Characteristics of Ischemic Brain Lesions After Stenting or Endarterectomy for Symptomatic Carotid Artery Stenosis : Results From the International Carotid Stenting Study-Magnetic Resonance Imaging Substudy (ICSS-MRI). Reference: Henrik Gensicke et al. Stroke 2013;44:80-86.

This work is a sub-study using magnetic resonance imaging (MRI) of the International Carotid Stenting Study (ICSS) that randomized carotid angioplasty (CAS) or endarterectomy (CEA) in patients with symptomatic carotid lesions. 

We analyzed the number of new lesions using MRI by volume, location and subgroups of patients. A total of 231 patients were included (124 patients received CAS and 107 CEA). The proportion of patients with one MRI lesion was 15% for CAS and 8% for CEA, whereas 2 to 5 lesions was 19% versus 5% respectively and with over 5 lesions 16% versus 4% respectively. In the subgroup analysis, relative risk was higher for patients with a systolic pressure below 158 mmHg at the time of randomization, diabetes, hemispheric stroke as index event or left carotid injury.

When analyzing the total injuries in patients, it was identical between CAS and CEA (p = 0.18) since the average size of each lesion in the CAS group was significantly smaller than in the CEA group, (0.02 ml versus 0.08 ml, P <0.0001), which offset the higher number.

Conclusion 

Patients with symptomatic carotid lesions have a greater number of lesions observed by MRI post angioplasty than post endarterectomy but these lesions are significantly smaller.

Editorial Comment:

The highest number of injuries and being smaller in turn with CAS are justified by microemboli during the procedure. Nevertheless, the clinical impact of these small lesions is unknown. In general, it is more likely that small lesions are reversible and silent compared with larger lesions. It needs investigating whether these small lesions may influence cognitive ability. Patients presenting hemispheric stroke had more new lesions with angioplasty than those with transient ischemic attack. However, this difference was not seen with endarterectomy, which may make the latter more secure to treat patients with stroke.

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