Ischemic brain injury during carotid artery stenting

Carotid angioplasty with stenting is a safe and effective way of primary and secondary prevention of ischemic stroke in patients with stenotic lesions of the internal carotid artery. However, the performance of such procedures is associated with the risk of perioperative cerebrovascular events due to arterio-arterial embolism in the cerebral artery and vasospasm. The article analyzes the results of stenting of the internal carotid arteries in 64 symptomatic and asymptomatic patients with atherosclerotic lesions of >70%. Acute ischemic brain lesions after stenting, according to diffusion-weighted MRI, were revealed in 40% of cases, while only in 6% of patients they manifested themselves clinically by focal neurological symptoms. A direct correlation between the number and size of brain infarcts and the occurrence of neurological symptoms was found. Intraoperative monitoring of middle cerebral artery blood flow dur- ing stent placement allows us to predict the appearance of acute ischemic foci in the brain, to clarify the genesis of perioperative stroke, as well as to evaluate the clinical relevance of vasospasm and microembolic signals. The findings should focus the attention of neurologists and angiosurgeons on an active postoperative monitoring of patients who have undergone carotid stenting with the aim of adequate personalized neuroprotective therapy, including preventive strategies.