Factors Associated With Silent Brain Infarcts After Middle Cerebral Artery Stenting or Balloon Angioplasty

Abstract

Background and Purpose

Silent brain infarcts (SBIs), which manifest as dot-like lesions on diffusion-weighted imaging (DWI) after endovascular procedures, are associated with an increased risk of stroke, dementia, and cognitive decline. We aimed to identify the factors associated with SBIs following middle cerebral artery (MCA) stenting or balloon angioplasty.

Methods

We retrospectively reviewed patients who underwent MCA stenting or balloon angioplasty, including those with symptomatic, atherosclerotic MCA stenosis of ≥50%. DWI scans were conducted before and after the procedure, and newly detected DWI lesions were classified as SBIs. We investigated the factors associated with the development of SBIs, and for patients with SBIs, we conducted a detailed analysis based on lesion location (cortex and perforator territory vs. cortex only vs. perforator territory only).

Results

Among 120 patients, 64 (53.3%) exhibited SBIs postprocedure. Factors significantly associated with SBIs included smaller stenosis diameter (odd ratio [95% confidence interval] = 0.03 [0.002–0.35], p = 0.006), longer stenosis length (1.24 [1.02–1.51], p = 0.033), higher MCA tortuosity (1.20 [1.07–1.34], p = 0.002), and diffuse involvement of MCA stenosis (3.99 [1.17–13.62], p = 0.027). Among the patients who exhibited SBIs, D-dimer (p = 0.002), C-reactive protein (p = 0.026), and hemoglobin A1c (p = 0.025) differed according to detailed mechanism.

Conclusions

Stenosis diameter, stenosis length, and MCA tortuosity were significantly associated with the development of SBIs following MCA stenting.