{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T09:53:11Z","timestamp":1767865991105,"version":"3.49.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Complex vascular anatomy might increase the risk of procedural stroke during carotid artery stenting (CAS). Randomized controlled trial evidence that vascular anatomy should inform the choice between CAS and carotid endarterectomy (CEA) has been lacking.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>One-hundred eighty-four patients with symptomatic internal carotid artery stenosis who were randomly assigned to CAS or CEA in the ICSS (International Carotid Stenting Study) underwent magnetic resonance (n=126) or computed tomographic angiography (n=58) at baseline and brain magnetic resonance imaging before and after treatment. We investigated the association between aortic arch configuration, angles of supra-aortic arteries, degree, length of stenosis, and plaque ulceration with the presence of \u22651 new ischemic brain lesion on diffusion-weighted magnetic resonance imaging (DWI+) after treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              Forty-nine of 97 patients in the CAS group (51%) and 14 of 87 in the CEA group (16%) were DWI+ (odds ratio [OR], 6.0; 95% confidence interval [CI], 2.9\u201312.4;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In the CAS group, aortic arch configuration type 2\/3 (OR, 2.8; 95% CI, 1.1\u20137.1;\n              <jats:italic>P<\/jats:italic>\n              =0.027) and the degree of the largest internal carotid artery angle (\u226560\u00b0 versus &lt;60\u00b0; OR, 4.1; 95% CI, 1.7\u201310.1;\n              <jats:italic>P<\/jats:italic>\n              =0.002) were both associated with DWI+, also after correction for age. No predictors for DWI+ were identified in the CEA group. The DWI+ risk in CAS increased further over CEA if the largest internal carotid artery angle was \u226560\u00b0 (OR, 11.8; 95% CI, 4.1\u201334.1) than if it was &lt;60\u00b0 (OR, 3.4; 95% CI, 1.2\u20139.8; interaction\n              <jats:italic>P<\/jats:italic>\n              =0.035).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Complex configuration of the aortic arch and internal carotid artery tortuosity increase the risk of cerebral ischemia during CAS, but not during CEA. Vascular anatomy should be taken into account when selecting patients for stenting.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.isrctn.com\/ISRCTN25337470\">http:\/\/www.isrctn.com\/ISRCTN25337470<\/jats:ext-link>\n              . Unique identifier: ISRCTN25337470.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.116.014612","type":"journal-article","created":{"date-parts":[[2017,4,12]],"date-time":"2017-04-12T01:10:24Z","timestamp":1491959424000},"page":"1285-1292","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":61,"title":["Vascular Anatomy Predicts the Risk of Cerebral Ischemia in Patients Randomized to Carotid Stenting Versus Endarterectomy"],"prefix":"10.1161","volume":"48","author":[{"given":"Mandy D.","family":"M\u00fcller","sequence":"first","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank J.","family":"Ahlhelm","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"von Hessling","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Doig","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul J.","family":"Nederkoorn","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumaira","family":"Macdonald","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe A.","family":"Lyrer","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aad","family":"van der Lugt","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroen","family":"Hendrikse","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Stippich","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Bart","family":"van der Worp","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toby","family":"Richards","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin M.","family":"Brown","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan T.","family":"Engelter","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo H.","family":"Bonati","sequence":"additional","affiliation":[{"name":"From the Department of Neurology and Stroke Center (M.D.M., P.A.L., S.T.E., L.H.B.) and Division of Diagnostic and Interventional Neuroradiology (F.J.A., A.v.H., C.S.), University Hospital Basel, Switzerland; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology (D.D., M.M.B., L.H.B.) and Division of Surgery and Interventional Science (T.R.), University College London, United Kingdom; Department of Neurology, Academic Medical Center Amsterdam, the..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61184-3"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01309-4"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.23483"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10016-005-8045-4"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2007.08.027"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.588772"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.547117"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2006.12.059"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12084"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(10)70057-0"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.6.711"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.186.2.8421726"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.25.6.1130"},{"key":"e_1_3_4_15_2","volume-title":"Manual of Peripheral Vascular Intervention","author":"Casserly IP","year":"2005","unstructured":"Casserly IP, Sachar R, Yadav JS. 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