(1) Study purpose: The aim of our prospective single-center, matched case-control
study was to compare the number and volume of acute ischemic brain lesions following
carotid endarterectomy (CEA) versus carotid artery stenting (CAS) using a propensity-matched
design. (2) Methods: Carotid bifurcation plaques were analyzed by using VascuCAP software
on CT angiography (CTA) images. The number and volume of acute and chronic ischemic
brain lesions were assessed on MRI scans taken 12-48 h after the procedures. Propensity
score-based matching was performed at a 1:1 ratio to compare the ischemic lesions
on postinterventional MR. (3) Results: A total of 107 patients (CAS, N = 33; CEA,
N = 74) were included in the study. There were significant differences in smoking
(p = 0.003), total calcification plaque volume (p = 0.004), and lengths of the lesion
(p = 0.045) between the CAS and CEA groups. Propensity score matching resulted in
21 matched pairs of patients. Acute ischemic brain lesions were detected in ten patients
(47.6%) of the matched CAS group and in three patients (14.2%) in the matched CEA
group (p = 0.02). The volume of acute ischemic brain lesions was significantly larger
(p = 0.04) in the CAS group than in the CEA group. New ischemic brain lesions were
not associated with neurological symptoms in either group. (4) Conclusions: Procedure-related
new acute ischemic brain lesions occurred significantly more frequently in the propensity-matched
CAS group.
