{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:05:54Z","timestamp":1790949954200,"version":"4.1.0"},"reference-count":24,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis Extra"],"abstract":"<jats:p>Introduction: Despite recent advances in stents and stenting techniques, ischemic complications associated with carotid artery stenting (CAS) remain unresolved. Although plaque characteristics have attracted attention as risk factors, only a few studies have focused on access routes. This study aimed to identify ischemic factors following CAS, including access routes and plaque instability, using computed tomography angiography (CTA). Methods: We retrospectively collected the clinical data of consecutive patients who underwent CAS and preoperative CTA. The access route was evaluated as having aortic plaques and a stenosis at proximal segment lesions beyond carotid plaques (brachiocephalic\/common carotid artery). Aortic plaques were further classified based on the presence or absence of calcifications. The outcome was the presence of hyperintense lesions (ipsilateral\/non-ipsilateral\/bilateral) on postoperative diffusion-weighted imaging (DWI). Multivariate analysis was conducted using two models: aortic plaques (Model 1) and calcified aortic plaques (Model 2). Results: Among the 115 patients who underwent CAS, the mean age was 74.7 years, and 16 (13.9%) were female. Aortic arch plaques were detected in 33 (28.7%) cases, and calcified plaques in 10 (8.7%). Plaques at proximal segment lesions were detected in 27 (23.5%) cases. DWI lesions were detected in 49 (42.6%) cases; 41 (35.7%) on the ipsilateral side, 19 (16.5%) on the non-ipsilateral side, and 11 (9.6%) bilaterally. The following variables were significantly associated in the univariate analysis: age (ipsilateral, p = 0.005; non-ipsilateral, p = 0.007; bilateral, p = 0.005), proximal segment lesions (ipsilateral, p = 0.04; non-ipsilateral, p = 0.002; bilateral, p = 0.02), aortic plaques (non-ipsilateral, p &lt; 0.001; bilateral, p &lt; 0.001), and calcification (non-ipsilateral, p &lt; 0.001; bilateral, p &lt; 0.001). For ipsilateral lesions, proximal segment lesions were associated in both models (Model 1: odds ratio [OR], 4.30; 95% confidence interval [95% CI], 1.5\u201313.5; p = 0.006, and Model 2: OR: 4.40; 95% CI: 1.6\u201313.5; p = 0.004). For non-ipsilateral and bilateral lesions, aortic plaques (non-ipsilateral: OR: 5.33; 95% CI: 1.8\u201316.5; p = 0.002; bilateral: OR, 13.16; 95% CI: 3.0\u201393.4; p = 0.001) and calcification (non-ipsilateral: OR: 11.55; 95% CI: 2.6\u201363.0; p = 0.001; bilateral: OR: 18.51; 95% CI: 3.7\u2013106.5; p = 0.0003) were associated in both models. Conclusion: Ischemic lesions are likely to occur after CAS, depending on the access route. CTA, which allows the evaluation of access routes, is a useful modality for predicting ischemic lesions after CAS.<\/jats:p>","DOI":"10.1159\/000549798","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T17:12:00Z","timestamp":1764609120000},"page":"1-8","source":"Crossref","is-referenced-by-count":1,"title":["Ischemic Lesions in Diffusion-Weighted Imaging after Carotid Artery Stenting: Correlation with Access Route"],"prefix":"10.1159","volume":"16","author":[{"given":"Koji","family":"Shimonaga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshito","family":"Hirata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masakazu","family":"Mitsunobu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Ogami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Kiura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Tominaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobutaka","family":"Horie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040127"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1515706"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.21359"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.12.047"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0912321"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.112.000093"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-020-02447-3"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1177\/1591019916633242"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.2176\/nmc.oa.2018-0023"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.005190"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.15142300"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.615708"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.3171\/2010.3.JNS091057"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A7443"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1159\/000347073"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199811123392002"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.11.005"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62038-3"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-014-2311-6"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1550014"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.624155"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaa210"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1053\/j.semvascsurg.2011.03.001"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2020.06.040"}],"container-title":["Cerebrovascular Diseases Extra"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000549798","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T17:00:53Z","timestamp":1768323653000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000549798"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,28]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000549798","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.30731042","asserted-by":"subject"}]},"ISSN":["1664-5456"],"issn-type":[{"value":"1664-5456","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,28]]}}}