CLINICAL INVESTIGATION ARTERIAL INTERVENTIONS Early Embolization After Carotid Artery Stenting with Mesh- Covered Stent: Role of Diffusion-Weighted Magnetic Resonance Imaging as Pre-procedural Predictor and Discriminant Between Intra- and Post-procedural Events M. A. Ruffino 1 • R. Faletti 2 • M. Fronda 2 • M. Gatti 2 • L. Bergamasco 3 • L. Gibello 4 • G. Varetto 4 • D. Righi 1 • P. Rispoli 4 • P. Fonio 2 Received: 15 September 2018 / Accepted: 30 January 2019 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019 Abstract Objectives To evaluate the incidence and the time of onset of early micro-embolism after CAS (carotid artery stent- ing) with two different mesh-covered stents and to assess the role of DW-MRI (Diffusion-weighted magnetic reso- nance imaging) in their prediction. Methods Single-institution prospective study including 50 patients (33 male, median age 74 years) who underwent CAS with Roadsaver Ò or CGuard TM . All patients with primary stenosis (37/50, 74%) had carotid plaque DW-MRI pre-procedure, with both qualitative evaluation of the hyperintensity and ADC (apparent diffusion coefficient) measurement of the plaque. All patients had brain DW- MRI pre-procedure, at 1 h, 24 h and 30 days post-proce- dure to evaluate the appearance of hyperintense lesions over time. Imaging analysis was performed in a double- blinded fashion by two radiologists. Results There were no statistically significant differences between the two stents both in the incidence at 1h (P = 0.23) and 24 h (P = 0.36) and in the volume of new DWI hyperintense brain lesions at 24 h (P = 0.27). Thirty- four new asymptomatic lesions in 19 patients (38%) were reported: 4 (11.8%) at 1 h, 30 (88.2%) at 24 h. The 30-day DWI-MR showed complete resolution of all lesions and no evidence of new lesion. The incidence of new lesions at 24 h resulted significantly higher in patients with DWI hyperintense carotid plaques (12/16, 75% vs. 0/21, 0%, P \ 0.0001). This result was paralleled by the difference in ADC value (0.83 ± 0.21 vs. 1.42 ± 0.52). Conclusion The majority of early asymptomatic brain lesion occurred during the first 24 h after CAS. Pre-pro- cedure high DWI signal of the plaque was associated with an increased incidence of post-procedure microem- bolizations. & M. Fronda marco.fronda87@gmail.com M. A. Ruffino mruffino@cittadellasalute.to.it R. Faletti riccardo.faletti@unito.it M. Gatti marcogatti17@gmail.com L. Bergamasco laura.bergamasco@gmail.com L. Gibello lorenzo.gibello@unito.it G. Varetto gianfranco.varetto@unito.it D. Righi dorico.righi@yahoo.it P. Rispoli pietro.rispoli@unito.it P. Fonio paolo.fonio@unito.it 1 Department of Diagnostic Imaging and Radiotherapy - Vascular Radiology, Citta ` della Salute e della Scienza di Torino, Turin, Italy 2 Department of Surgical Sciences - Radiology Unit, University of Turin, Turin, Italy 3 Department of Surgical Sciences, Citta ` della Salute e della Scienza di Torino, Turin, Italy 4 Department of Surgical Sciences – Vascular Surgery, University of Torino, Turin, Italy 123 Cardiovasc Intervent Radiol https://doi.org/10.1007/s00270-019-02173-1