New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS)
New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS)
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DOI：
10.1016/s1474-4422(10)70057-0
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发表时间：
2010-04-01
期刊：
影响因子：
48
通讯作者：
Engelter, Stefan T.
中科院分区：
文献类型：
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作者：
Bonati, Leo H.;Jongen, Lisa M.;Engelter, Stefan T.
国际颈动脉支架植入术研究（ICSS）发现，与动脉内膜切除术相比，支架植入术后30天内卒中的发生率更高。我们的目的是比较率缺血性脑损伤检测MRI两groups.Methods最近症状性颈动脉狭窄ICSS患者随机分配在1：1的比例接受颈动脉支架植入术或动脉内膜切除术。在ICSS的50个中心中，7个中心参加了MRI子研究，方案规定在治疗前1-7天、治疗后1-3天（治疗后扫描）和治疗后27-33天进行MRI。由两名或三名对治疗不知情的研究者分析扫描结果。主要终点是治疗后扫描弥散加权成像（DWI）显示至少一处新的缺血性脑病变。分析符合方案。这是一项注册试验ISRCTN 25337470的子研究。结果231例患者（支架组124例，动脉内膜切除术组107例）在治疗前后进行了MRI检查。支架组124例患者中有62例（50%）和动脉内膜切除术组107例患者中有18例（17%）在治疗后1天（中位数）进行的治疗后扫描中检测到至少一个新的DWI病变（校正比值比[OR] 5.21，95%CI 2.78-9.79; p
Background The international Carotid Stenting Study (ICSS) of stenting and endarterectomy for symptomatic carotid stenosis found a higher incidence of stroke within 30 days of stenting compared with endarterectomy. We aimed to compare the rate of ischaemic brain injury detectable on MRI between the two groups.Methods Patients with recently symptomatic carotid artery stenosis enrolled in ICSS were randomly assigned in a 1:1 ratio to receive carotid artery stenting or endarterectomy. Of 50 centres in ICSS, seven took part in the MRI substudy, The protocol specified that MRI was done 1-7 days before treatment, 1-3 days after treatment (post-treatment scan), and 27-33 days after treatment. Scans were analysed by two or three investigators who were masked to treatment. The primary endpoint was the presence of at least one new ischaemic brain lesion on diffusion-weighted imaging (DWI) on the post-treatment scan. Analysis was per protocol. This is a substudy of a registered trial, ISRCTN 25337470.Findings 231 patients (124 in the stenting group and 107 in the endarterectomy group) had MRI before and after treatment. 62 (50%) of 124 patients in the stenting group and 18 (17%) of 107 patients in the endarterectomy group had at least one new DWI lesion detected on post-treatment scans done a median of 1 day after treatment (adjusted odds ratio [OR] 5.21, 95% CI 2.78-9.79; p