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Late Cerebral Ischemia Common After Carotid Stenting

Ischemia can develop in either hemisphere within 18 hours

THURSDAY, Oct. 23 (HealthDay News) -- Nearly one in five patients who have undergone emboli-protected carotid artery stenting will develop cerebral ischemia in either hemisphere within 18 hours after the procedure, according to a report in the October issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

Joachim Schofer, M.D., from Hamburg University Cardiovascular Center in Germany, and colleagues used diffusion-weighted MRI to assess the timing and location of cerebral ischemia after emboli-protected carotid artery stenting in 58 patients who underwent 59 procedures.

The researchers found that a mean of 3.5 hours after the procedure, 20.3 percent of scans (12 scans) showed new ischemic foci, all in the ipsilateral hemisphere. After a mean of 18 hours, 17 percent of scans (seven with recent ischemic foci, three previously positive scans with additional foci) showed late cerebral ischemia. Of the 10 scans showing late ischemia, 40 percent had foci in the contralateral hemisphere. There were no overt neurological complications associated with cerebral ischemia out to 30 days, the authors report.

"Preventive measures to possibly reduce the incidence of cerebral embolization should focus not only on the target lesion, but also on the access vasculature," Schofer and colleagues conclude. "Patients should be monitored and diffusion-weighted MRI delayed for at least 18 hours after the intervention."

An author of the editorial discloses a financial relationship with the pharmaceutical industry.

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