From the Department of Interventional Neuroradiology (Z.H., L.Y., W.F., Y.Y., L.J., J.Y., Z.M., N.M.), Department of Neurosurgery (Z.H.), Tiantan Neuroimaging Center of Excellence (J.J., Z.Z., Y.W.), and Department of Neurology (J.J., J.L., Y.W.), Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing 100070, China; China National Clinical Research Center for Neurologic Diseases, Beijing, China (Z.H., J.J., L.Y., Z.Z., W.F., J.L., Y.Y., L.J., J.Y., Y.W., Z.M., N.M.); and Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China (X.L.).
Radiology. 2023 May;307(4):e221499. doi: 10.1148/radiol.221499. Epub 2023 Mar 28.
Background There are limited data on new ischemic brain lesions after endovascular treatment for symptomatic intracranial atherosclerotic stenosis (ICAS). Purpose To investigate the characteristics of new ischemic brain lesions at diffusion-weighted MRI (new diffusion abnormalities) after endovascular treatment, characteristics between those treated with balloon angioplasty and stent placement procedures, and predictors of new ischemic brain lesions. Materials and Methods Patients with symptomatic ICAS in whom maximum medical therapy failed were prospectively enrolled between April 2020 and July 2021 from a national stroke center and underwent endovascular treatment. All study participants underwent thin-section diffusion-weighted MRI (voxel size, 1.4 × 1.4 × 2 mm with no section gap) before and after treatment. The characteristics of new ischemic brain lesions were recorded. Multivariable logistic regression analysis was performed to determine potential predictors of new ischemic brain lesions. Results A total of 119 study participants (mean age, 59 years ± 11 [SD]; 81 men; 70 treated with balloon angioplasty and 49 with stent placement) were enrolled. Of the 119 participants, 77 (65%) had new ischemic brain lesions. Five of the 119 participants (4%) had symptomatic ischemic stroke. New ischemic brain lesions were located in (61%, 72 of 119) and/or beyond (35%, 41 of 119) the territory of the treated artery. Of the 77 participants with new ischemic brain lesions, 58 (75%) had lesions located in peripheral brain areas. There was no evidence of a difference in the frequency of new ischemic brain lesions between the balloon angioplasty and stent groups (60% vs 71%, = .20). In adjusted models, cigarette smoking (odds ratio [OR], 3.6; 95% CI: 1.3, 9.7) and more than one operative attempt (OR, 2.9; 95% CI: 1.2, 7.0) were independent predictors of new ischemic brain lesions. Conclusion New ischemic brain lesions on diffusion-weighted MRI scans were common after endovascular treatment for symptomatic intracranial atherosclerotic stenosis, and occurrence may be associated with cigarette smoking and the number of operative attempts. Clinical trial registration no. ChiCTR2100052925 © RSNA, 2023 See also the editorial by Russell in this issue.
在症状性颅内动脉粥样硬化性狭窄（ICAS）的血管内治疗后，新的缺血性脑病变（新的弥散异常）的数据有限。目的：探讨血管内治疗后弥散加权 MRI（DWI）上新的缺血性脑病变（new diffusion abnormalities）的特征，球囊血管成形术和支架置入术之间的特征，以及新的缺血性脑病变的预测因素。材料与方法：2020 年 4 月至 2021 年 7 月，全国卒中中心前瞻性招募了症状性 ICAS 患者，这些患者对最大药物治疗无效，接受了血管内治疗。所有研究参与者在治疗前后均进行了薄层弥散加权 MRI（体素大小为 1.4×1.4×2mm，无层间间隙）。记录新的缺血性脑病变的特征。采用多变量逻辑回归分析确定新的缺血性脑病变的潜在预测因素。结果：共纳入 119 名研究参与者（平均年龄 59 岁±11[标准差]；81 名男性；70 名接受球囊血管成形术治疗，49 名接受支架置入术治疗）。119 名参与者中，77 名（65%）有新的缺血性脑病变。119 名参与者中有 5 名（4%）发生症状性缺血性卒中。新的缺血性脑病变位于（61%，119 名中有 72 名）和/或治疗动脉以外的区域（35%，119 名中有 41 名）。77 名有新的缺血性脑病变的参与者中，58 名（75%）的病变位于脑的周边区域。球囊血管成形术组和支架组新的缺血性脑病变的发生率无差异（60%比 71%， =.20）。在调整后的模型中，吸烟（比值比[OR]，3.6；95%置信区间：1.3，9.7）和超过一次手术尝试（OR，2.9；95%置信区间：1.2，7.0）是新的缺血性脑病变的独立预测因素。结论：血管内治疗症状性颅内动脉粥样硬化性狭窄后，弥散加权 MRI 扫描上新的缺血性脑病变很常见，其发生可能与吸烟和手术次数有关。临床试验注册号：ChiCTR2100052925 ©RSNA，2023 本期还刊登了 Russell 等人的评论文章。
