Recent Intraplaque Hemorrhage is Associated with a Higher Risk of Ipsilateral Cerebral Embolism during Carotid Artery Stenting

Abstract Objective The purpose of this study was to identify which stage of intraplaque hemorrhage (IPH) is an independent risk factor for ipsilateral new ischemic lesions (NILs) after carotid artery stenting (CAS). Methods In 268 patients treated with CAS, the association between postoperative ipsilateral NILs on diffusion-weighted imaging (DWI) and patient demographics, intraoperative factors, and plaque characteristics on multi-contrast atherosclerosis characterization (MATCH) sequence was retrospectively analyzed. Results A total of 268 patients were enrolled in the study. Ipsilateral NILs on DWI were detected in 32.8% patients. Univariate analysis showed that the stage of IPH (along with lipid-rich necrotic core [LRNC]) (P 0.05), type of embolic protection device (P = 0.072), postdilation (P = 0.388), calcification (P = 0.140), and lipid-rich necrotic core (without IPH) (P = 0.086) were not. Multivariate logistic regression analysis showed that the acute and recent IPH (along with LRNC) (odds ratio [OR]: 3.78, P = 0.011 and OR: 16.73, P Conclusions Screening for recent IPH in carotid plaques using MATCH sequence may identify plaques at a higher risk for cerebral embolism during CAS.