Author + information
- Kosmas I. Paraskevas, MD∗ ( and )
- Athanasios D. Giannoukas, MD, MSc, PhD
- ↵∗Department of Vascular Surgery, Larissa University Hospital of Larissa, Larissa 41000, Greece
The paper by Bijuklic et al. (1) in JACC: Cardiovascular Interventions evaluated the impact of new asymptomatic cerebral ischemic lesions in diffusion-weighted magnetic resonance imaging (DW-MRI) after carotid artery stenting (CAS). New post-procedural asymptomatic cerebral ischemic lesions on DW-MRI were demonstrated in 241 of 728 CAS patients (32.8%). By multivariate Cox regression analysis, a positive cerebral DW-MRI after CAS had no prognostic impact on major adverse cerebral and cardiovascular events (1).
The investigators mention that 1 limitation of their study is that they did not perform any neuropsychological testing (1). This limitation was addressed in another recent paper (2). In this study, 37 patients scheduled to undergo CAS underwent brain DW-MRI and neuropsychological evaluation before, as well as after, the procedure. At least 1 new post-procedural asymptomatic cerebral ischemic lesion on DW-MRI was detected in 9 of 37 patients (24%). It was demonstrated that CAS-induced new post-procedural asymptomatic cerebral ischemic lesions on DW-MRI had a negative impact on cognitive functions as assessed by the following verbal memory tests (2): Mini-Mental State Examination (MMSE; mean MMSE change: –1.5; 95% confidence interval [CI]: from –2.8 to –0.2 vs. +0.5; 95% CI: from –0.3 to +1.3, for patients with vs. without new ischemic lesions on DW-MRI; p = 0.017); the Rey Auditorial Verbal Learning Test-Immediate (RAVLT-I); RAVLT-I scores: 31.6 ± 8.8 vs. 39.9 ± 5.6, for patients with vs. without new ischemic lesions on DW-MRI; p = 0.003); and the RAVLT-Delayed (RAVLT-D); RAVLT-D scores: 6.1 ± 1.6 vs. 7.9 ± 1.6, for patients with vs. without new ischemic lesions on DW-MRI; p = 0.015). As correctly mentioned by the investigators, this is the first report showing an association between asymptomatic cerebral lesions on DW-MRI and cognitive functions (2).
Although asymptomatic cerebral lesions in DW-MRI after CAS may not predict future major adverse cerebral and cardiovascular events (1), preliminary evidence suggests that these lesions may have a negative impact on cognitive functions (2). Furthermore, it has been suggested that, compared with carotid endarterectomy, CAS is associated with higher microembolization rates (3). Future studies should investigate the impact of asymptomatic cerebral lesions in DW-MRI on future major adverse cerebral and cardiovascular events and cognitive functions after CAS compared with carotid endarterectomy.
- American College of Cardiology Foundation