Microbleeds after Carotid Artery Stenting: Small Embolism May Induce Cerebral Microbleeds
Microbleeds after Carotid Artery Stenting: Small Embolism May Induce Cerebral Microbleeds
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DOI：
10.1159/000500112
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发表时间：
2019-01-01
影响因子：
1.9
通讯作者：
Tomimoto, Hidekazu
中科院分区：
文献类型：
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作者：
Ito, Ai Ogawa;Shindo, Akihiro;Tomimoto, Hidekazu
背景：自从磁共振成像技术出现以来，脑微出血可以在体内诊断。然而，脑微出血形成的潜在机制尚未完全了解。目的：本研究旨在确定颈动脉支架植入术（CAS）后脑微出血的相关因素。方法：回顾性分析125例因颈动脉狭窄行CAS的患者。在CAS前后使用T2* 加权梯度回波（GRE）成像研究脑微出血。我们分析了新发微出血与以下风险因素的可能关联：基线微出血和缺血性脑病变的数量、脑过度灌注综合征的发生率和CAS后新发缺血性脑病变。结果：在53例患者（42.4%）中检测到基线脑微出血。125例患者中有13例（10.4%）在CAS后观察到新发脑微出血，仅与新发缺血性病变相关，而与其他风险因素无关。没有患者在GRE成像上显示新的脑微出血的合并图像，或在扩散加权成像上显示新的缺血性病变。分别在12/13例（92.3%）和1例患者（7.7%）中观察到肺叶和深部微出血。在12例新发微出血患者中，10例（76.9%）和2例（15.4%）分别在同侧和对侧半球新发微出血。结论：我们发现CAS后出现了新的脑微出血，这些微出血可能与新的缺血性病变有关，主要发生在接受治疗的颈动脉区域。我们推测这些微出血是由于栓子中血红蛋白的脱氧，或者是缺血性病变的小出血性转化。
Background: Since the advent of magnetic resonance imaging technology, cerebral microbleeds can be diagnosed in vivo. However, the underlying mechanism of cerebral microbleed formation is not fully understood. Objectives: This study aimed to identify the factors associated with cerebral microbleeds after carotid artery stenting (CAS). Method: We retrospectively examined 125 patients who underwent CAS for carotid stenosis. Cerebral microbleeds were investigated using T2*-weighted gradient-echo (GRE) imaging before and after CAS. We analyzed the possible association of new microbleeds with the following risk factors: the number of baseline microbleeds and ischemic cerebral lesions, the occurrence of cerebral hyperperfusion syndrome, and new ischemic cerebral lesions after CAS. Results: Baseline cerebral microbleeds were detected in 53 patients (42.4%). New cerebral microbleeds after CAS were observed in 13 of 125 patients (10.4%) and were exclusively associated with new ischemic lesions but not with other risk factors. No patient showed a merged image of a new cerebral microbleed on GRE imaging or a new ischemic lesion on diffusion-weighted imaging. Lobar and deep microbleeds were noted in 12/13 (92.3%) and 1 patient (7.7%), respectively. Of 12 patients with new microbleeds, 10 (76.9%) and 2 (15.4%) had a new microbleed in the ipsilateral and contralateral hemispheres, respectively. Conclusions: We found that new cerebral microbleeds developed after CAS and that these might be associated with new ischemic lesions, mostly in the territory of the treated carotid artery. We speculate that these microbleeds result from the deoxygenation of hemoglobin in the embolus or, alternatively, small hemorrhagic transformation of ischemic lesions.