Evaluation of the risk factors and clinical features of newly developing cerebral microbleeds following internal carotid artery stenting

Q: What are the key findings of this study?

Internal carotid artery stenting resulted in new cerebral microbleeds in 25% of patients, significantly associated with symptomatic stenosis (OR 11.351, p=0.030) and lower hemoglobin (OR 0.636, p=0.008).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Internal carotid artery stenosis undergoing stenting (n=80). Intervention: Symptomatic internal carotid artery stenosis vs. Asymptomatic internal carotid artery stenosis. Primary outcome: Newly developing cerebral microbleeds (CMBs) on susceptibility-weighted imaging 72 hours after internal carotid artery stenting (OR 11.351, 95% CI 1.274-101.168, p=0.030).

Q: What does this research mean for the field?

New cerebral microbleeds occur in 25% of patients following internal carotid artery stenting and are independently associated with symptomatic stenosis, lower hemoglobin levels, and higher craniocervical atherosclerotic burden. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yasemin Dinç; Rıfat Özpar; Emel Oğuz Akarsu; Furkan Sarıdaş; Gizem Güllü; Mustafa Bakar; Bahattin Hakyemez

doi:10.55697/tnd.2026.585

August 27, 2026Turkish Journal Of NeurologyOpen Access

Evaluation of the risk factors and clinical features of newly developing cerebral microbleeds following internal carotid artery stenting

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Key result

Symptomatic stenosis is linked to ~11.4-fold higher odds of new cerebral microbleeds after carotid stenting.

OR 11.351
95% CI 1.274-101.168
P=0.030
n=80

Why the study?

The clinical features and risk factors of newly developing cerebral microbleeds (CMBs) following internal carotid artery (ICA) stenting needed to be characterized.

What are the clinical features and risk factors associated with newly developing cerebral microbleeds at 72 hours in patients with >=70% internal carotid artery stenosis undergoing carotid artery stenting?

Key Points

To characterize the clinical features of incident cerebral microbleeds following internal carotid artery stenting and identify associated risk factors.
Retrospective observational study of 80 patients (mean age 64.95 ± 11.14 years; 82.50% male) who underwent internal carotid artery (ICA) stenting between January 2021 and June 2021.
Cranial MRI, diffusion MRI, arterial spin labelling perfusion MRI, and susceptibility-weighted imaging (SWI) were performed before stenting and 72 hours postprocedure.
New ipsilateral cerebral microbleeds were detected on postprocedure SWI in 20 of 80 patients (25%), and new diffusion restrictions occurred in 20 patients (25%).
Univariate analysis demonstrated significant associations between incident microbleeds and symptomatic ICA stenosis (p = 0.041) as well as hemoglobin levels (p = 0.030).
Multivariable logistic regression identified symptomatic ICA stenosis (OR = 11.351, 95% CI 1.274–101.168, p = 0.030), hemoglobin level (OR = 0.636, 95% CI 0.454–0.890, p = 0.008), age (OR = 0.877, 95% CI 0.799–0.962, p = 0.006), and craniocervical atherosclerosis burden score (OR = 1.423, 95% CI 1.090–1.857, p = 0.009) as significant predictors of new microbleeds.

Study Design

Type

Observational (n=80)

Blinding

Single-blind

Multicenter

No

Structured PICO

What are the clinical features and risk factors associated with newly developing cerebral microbleeds at 72 hours in patients with >=70% internal carotid artery stenosis undergoing carotid artery stenting?

P

Population

80 patients (mean age 65.0 years, 17.5% female) with internal carotid artery stenosis ≥70% undergoing stenting, free of atrial fibrillation and renal failure, evaluated at 72 hours and followed for 1 year.

E

Exposure

Transfemoral internal carotid artery (ICA) stenting using a closed-cell stent (Boston Wallstent) with a distal embolism protection filter device (FilterWire EZ), preceded by dual antiplatelet therapy (acetylsalicylic acid 100 mg/day and clopidogrel 75 mg/day) and intraprocedural intravenous heparin, with predilation (41.25% of patients) and postdilation (5.0- to 6.0-mm balloon at 6 to 10 atm for 10 to 30 sec).

O

Outcome

Incident cerebral microbleeds (CMBs), defined as round or ovoid hypointense foci <10 mm in diameter on susceptibility-weighted imaging (SWI) MRI at 72 hours post-procedure compared to 24 hours pre-procedure, evaluated by two blinded neuroradiologists.surrogate

Main Result

Odds Ratio: 11.351 (95% CI 1.274–101.168)

Absolute Event Rate: 30.5% vs 9.5%

p-value: p=0.030

New ipsilateral cerebral microbleeds occurred in 25% of patients within 72 hours after internal carotid artery stenting and were significantly associated with symptomatic stenosis, lower hemoglobin levels, and higher craniocervical atherosclerotic burden.

Limitations

Single-center retrospective design
Relatively small patient sample size (n=80) limiting generalizability
Lack of long-term imaging follow-up to assess the clinical implications of newly detected cerebral microbleeds
Single-center design
Relatively small patient population limiting generalizability
Clinical implications of CMBs detected on SWI could not be assessed through long-term follow-up
Retrospective observational study design

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Implication

New CMBs after ICA stenting may warrant surveillance in symptomatic or anemic patients; leaves open clinical relevance and need for prospective outcome studies.

Abstract

Objectives: This study aimed to characterize the clinical features of incident cerebral microbleeds (CMBs) following internal carotid artery (ICA) stenting and identify related risk factors. Patients and methods: This retrospective observational study included 80 patients who underwent ICA stenting between January 2021 and June 2021. All patients underwent cranial magnetic resonance imaging (MRI), diffusion MRI, arterial spin labelling perfusion MRI, and susceptibility-weighted imaging, which were performed before the ICA stenting procedure and 72 h after the procedure. Risk factors associated with CMBs were analyzed by comparing patients who developed new CMBs following ICA stenting with those who did not. Results: The mean age of the patients was 64.95 ± 11.14 years. Fourteen patients (17.50%) were female, and 66 (82.50%) were male. New CMBs were detected in 25% of the patients following the ICA stenting procedure. A statistically significant association was found between the development of new CMBs and the presence of symptomatic ICA stenosis and anemia but not with any of the other parameters. Conclusion: Considering the development of new CMBs as a potential predictor of intracranial hemorrhage may facilitate closer monitoring and the adoption of personalized treatment strategies for this patient population.

Discussion

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Cite This Study

Dinç et al. (2026) conducted an observational in Internal carotid artery stenosis undergoing stenting (n=80). Symptomatic internal carotid artery stenosis vs. Asymptomatic internal carotid artery stenosis was evaluated on Newly developing cerebral microbleeds (CMBs) on susceptibility-weighted imaging 72 hours after internal carotid artery stenting (OR 11.351, 95% CI 1.274-101.168, p=0.030). Internal carotid artery stenting resulted in new cerebral microbleeds in 25% of patients, significantly associated with symptomatic stenosis (OR 11.351, p=0.030) and lower hemoglobin (OR 0.636, p=0.008).

synapsesocial.com/papers/6af0db863c845ca7837ced5a https://doi.org/10.55697/tnd.2026.585

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Evaluation of the risk factors and clinical features of newly developing cerebral microbleeds following internal carotid artery stenting

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Evaluation of the risk factors and clinical features of newly developing cerebral microbleeds following internal carotid artery stenting

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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