Abstract Body: Objective: Silent brain infarctions (SBIs), which appear as dot-like lesions on diffusion-weighted imaging (DWI) after endovascular procedures, are associated with an increased risk of subsequent stroke, dementia and cognitive decline. Efforts to reduce SBIs are needed. The objective of our study is to identify 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 was performed before and after the procedure, and newly appeared DWI lesions were regarded as SBIs. We compared variables between patients with and without SBIs and investigated the factors associated with the occurrence of SBIs. Additionally, among those with SBIs, we further analyzed the differences based on lesion location (cortex only vs. involving perforator territory).
Results: Among 107 patients, 60 (56.1%) exhibited SBIs post-procedure. Factors significantly associated with SBIs included smaller diameter (OR [95% CI] = 0.03[0.003-0.42], p=0.008), and longer stenosis (1.24[1.03-1.50], p=0.024), higher MCA tortuosity (1.25[1.12-1.39], p<0.001), and diffuse involvement of MCA stenosis (4.55[1.40-14.74], p=0.012). Among the patients who exhibited SBIs, 41 (68.3%) had SBIs confined to the cortex, while 19 (31.7%) had SBIs involving the perforator territory. Longer pre-stent balloon length was significantly associated with perforator SBIs (13.5±2.5 for cortical SBIs only vs. 15.3±2.2 for perforator SBIs, p=0.016).
Conclusion: Stenosis diameter, length, and MCA tortuosity are significant factors for SBIs following MCA stenting. Additionally, the factors associated with SBIs vary depending on the lesion location.