ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Independent Risk Factors for New Ischemic Brain Lesions on Diffusion-Weighted Imaging After Carotid Artery Stenting: A Retrospective Study
- RC
Ruiling Chen
- BJ
Bin Jiang
- XZ
Xianjin Zhu
- QL
Qi Liu
- JS
Jinmei Sun
- YZ
Yingying Zhao
- XD
XIE DAN
- YZ
Yongbo Zhang
Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Abstract
Background: New ischemic brain lesions (NIBLs) detected by diffusion-weighted imaging (DWI) after carotid artery stenting (CAS) are common indicators of subclinical cerebrovascular injury. However, their predictors remain incompletely understood. This study aimed to identify independent predictors of post-CAS NIBLs to establish a practical clinical risk assessment framework. Methods: This single-center retrospective cohort study included 97 patients undergoing 104 CAS procedures between January 2014 and January 2020. All patients underwent preoperative and postoperative magnetic resonance imaging (MRI) with DWI within 72 hours after CAS. Clinical characteristics, laboratory parameters, perioperative hemodynamic changes, procedural factors, and medical therapy status were collected. Multivariable logistic regression was performed to identify independent predictors of NIBLs. Sensitivity analyses were conducted by adjusting for preoperative medical therapy and perioperative heart-rate-modulating medications. Results: Postoperative DWI detected NIBLs in 68 of 104 CAS procedures (65.4%). Two independent neuroradiologists showed excellent agreement for NIBL identification (Cohen’s κ=0.86). Multivariable analysis identified coronary heart disease (CHD) (OR=0.313, 95% CI: 0.104–0.939, p=0.038), high-density lipoprotein cholesterol (HDL-C) (OR=0.764, 95% CI: 0.587–0.996, p=0.046), total cholesterol (OR=3.329, 95% CI: 1.004–11.041, p=0.049), and postoperative heart-rate change (OR=1.069, 95% CI: 1.028–1.111, p=0.001) as independent factors associated with NIBLs. After adjustment for statin use, DAPT duration, BMT status, atropine administration, and beta-blocker use, these associations remained consistent. Conclusion: NIBLs frequently occur after CAS. The 3C-H framework (comprising CHD, cholesterol metabolism, and postoperative heart-rate change) effectively identifies patients at high risk for these lesions.
Summary
Keywords
carotid, Carotid artery stenting, Diffusion-weighted imaging, New ischemic brain lesions, Risk factors
Received
21 April 2026
Accepted
07 August 2026
Copyright
© 2026 Chen, Jiang, Zhu, Liu, Sun, Zhao, DAN and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yongbo Zhang
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