Impact of Additional Lipid-Lowering Therapy on New Ischemic Lesions of Diffusion-Weighted Imaging in Carotid Artery Stenting.

BACKGROUND: New ischemic lesions on diffusion-weighted imaging (DWI) are frequently found after carotid artery stenting (CAS) and sometimes cause neurologic deficit. We investigated the rate and the potential factor of new DWI lesions during the perioperative period of CAS in symptomatic patients at our institution.

MATERIALS AND METHODS: Of 187 consecutive patients who underwent CAS (April 2013-August 2016), we investigated 60 symptomatic patients with artery-to-artery embolism from carotid plaque. During hospitalization for ischemic stroke, patients with more than 120 mg/dL of plasma low-density lipoprotein cholesterol (LDL-C) level or more than 100 mg/dL of LDL-C level in case of coronary artery disease were administered additional lipid-lowering therapy (ALL therapy), for example, the same statin as patients took or evolocumab for patients with the maximum tolerated dose of statin. All patients were implanted the same type of carotid stent by the same procedure as we predefined. We implemented data analysis to identify factors on new DWI lesions.

RESULTS: New DWI lesions were observed in 17 patients (28%). Baseline plasma triglyceride level was found to be the factor of new DWI lesions. ALL therapy was administered to 26 patients, including 8 patients of evolocumab. The average period from the start of ALL therapy to CAS was 15 days. New DWI lesions occurred in 11.5% of patients with ALL therapy and 41.2% of patients without ALL therapy (P = .019). Multivariate logistic analysis showed that ALL therapy was an independent predictor of absence of new DWI lesions (P = .029).

CONCLUSIONS: ALL therapy before CAS may reduce new DWI lesions.