두개 내외 뇌동맥 스텐트 삽입술 후 확산강조영상에서 새롭게 발견된 뇌허혈 병변의 빈도와 특성
김미화1·김상흠2·이영준3·오승헌1·김현숙1·김원찬1·김옥준1
CHA 의과학대학교 신경과학교실,1 방사선과학교실,2 한양대학교 의과대학 방사선과학교실
Frequency and Characteristics of Newly Detected Cerebral Ischemic Lesions on Diffusion-Weighted Imaging after Stent Insertion of Intra- or Extracranial Cerebral Arteries
Mi-Hwa Kim, MD1, Sang Heum Kim, MD2, Young-Joon Lee, MD3, Seung-Hun Oh, MD1, Hyun Sook Kim, MD1, Won-Chan Kim, MD1 and Ok Joon Kim, MD, PhD1
1Departments of Neurology, 2Radiology, CHA University School of Medicine, Seongnam, Korea 3Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
ABSTRACT
Background: Small emboli arising from a friable plaque during intra-arterial procedure lead to cerebral ischemic lesion (CIL) in some patients with cerebral arterial stenosis. We investigate the frequency and characteristics of symptomatic or asymptomatic CIL after stent insertion in cerebral arterial stenosis. Methods: This study enrolled consecutive 40 patients who performed stent insertion for treatment of significant intra- and extra-cranial arterial stenosis. We compared serial diffusion-weighted imaging (DWI) of brain before and within 48 hours after intervention to detect newly developed CIL. The neurological deterioration was checked at the same time. Results: Twenty-seven of total 40 cases (67.5%) had newly developed CIL on follow-up DWI scan. Most CIL were multiple and dot-shaped lesions scattered in peripheries of intracranial arteries. Thirteen patients (48.1%) developed CIL at relevant arterial territory of procedure and the rest (51.9%) developed at combined relevant and irrelevant vascular territory or irrelevant vascular territory only. Most of cases with CIL (85%) were asymptomatic on follow-up neurological exam. In 4 symptomatic cases, three cases showed transient ischemic symptoms and one showed severe neurological deterioration. On comparison of risk factors between CIL-positive and CIL-negative groups, no differences in age, sex, vascular risk factors, operator and procedure time were found. Conclusions: The frequency of newly developed CIL after stent procedure is relatively high and most CIL were asymptomatic. However, in some case, neurological deterioration can occur. So then, to decrease CIL in stent procedure, intensive preventive therapy will be needed. Also, it is important to monitor the clinical symptoms carefully, and to use sufficient anticoagulation before and after stent procedure.
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