Ischaemic lesions of cerebral after carotid stenting

Medvedev R.B.¹, Tanashyan M.M.¹, Kuntsevich G.I.¹, Lagoda O.V.¹, Skrylev S.I.¹, Krotenkova M.V.¹, Koshcheev A.Yu.¹, Suslin A.S.¹, Gemdzhyan E.G.²

1) Research Centre of Neurology,
2) Haematological Research Centre of the Russian Health Ministry, Moscow, Russia

Carotid angioplasty with stenting is a reliable method of primary and secondary prevention of ischaemic stroke in patients with stenosing lesions of the internal carotid artery. However, carrying out such operations is sometimes associated with risk for the development of intraoperative impairments of cerebral circulation due to arterioarterial embolism in cerebral arteries, as well as vasospasm.

Presented herein are the results of following up a total of 64 patients with pronounced atherosclerotic lesions of internal carotid arteries (>70%) – "symptomatic" and "asymptomatic", undergoing carotid stenting. Acute foci of ischaemia in the brain after stenting according to the findings of diffusion-weighted magnetic resonance tomography were revealed in 40% of cases, and in only 6% of patients they manifested themselves by symptoms of acute cerebral circulatory impairment. We revealed a direct correlation between the number, size of infarctions in the brain, and the appearance of neurological symptomatology. Intraoperative monitoring of blood flow in the middle cerebral artery during stenting makes it possible to predict the appearance of acute foci of cerebral ischaemia, to specify the genesis of perioperative stroke, as well as to evaluate clinical significance of vasospasm and material microembolism. The obtained findings should concentrate neurologists’ attention on active postoperative follow up of patients subjected to carotid angioplasty with stenting in order to perform adequate personified neuroprotective correction, including preventive one.

KEY WORDS: carotid angioplasty with stenting, acute foci of cerebral ischaemia, diffusion-weighted magnetic resonance tomography, perioperative stroke, intraoperative monitoring of cerebral blood flow.

P. 71

« Back