• Hidemichi Ito, Masashi Uchida, Tomohiro Kaji, Yuki Go, Gaku Hidaka, Hiroshi Takasuna, Tetsuya Goto, Ichiro Takumi, and Yuichiro Tanaka.
• Department of Neurosurgery, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, Japan. Electronic address: hdmcito@marianna-u.ac.jp.
• World Neurosurg. 2020 Oct 1; 142: e290-e296.

BackgroundThis study analyzes the incidence of microembolic infarctions (MIs) in the cerebellum after carotid artery stenting (CAS) to determine the risk factors.MethodsFrom 2012 to 2019, 162 CASs in 155 patients were performed at our hospital. Fifty-seven patients (35.7%) showing new MIs on diffusion-weighted imaging after CAS were enrolled. Patients were assigned to either the cerebellar group (n = 14, 8.8%) if their MIs were in the cerebellum and/or cerebrum or the cerebral group (n = 43, 26.9%) if their MIs were only in the cerebrum. Patient characteristics, anatomic features, and clinical data were retrospectively compared between the 2 groups.ResultsAdvanced age, right-sided carotid stenosis, severe calcification of aortic arch and brachiocephalic trunk, and vertebral artery narrowing with intraprocedural hemodynamic depression (IHD) significantly increased the development of cerebellar MIs. On multivariate analysis, advanced age, right-sided carotid stenosis, and vertebral artery narrowing with IHD were independent predictors of developing new cerebellar MIs. Cerebellar MIs after CAS were not uncommon.ConclusionsCatheter maneuvering in the aortic arch or the brachiocephalic trunk could be the main cause of thromboemboli in cerebellar MIs. Careful attention should be paid to catheter maneuvering, especially in older patients with right-sided carotid lesions. In addition, cerebellar hypoperfusion caused by vertebral artery narrowing with IHD might reduce washout of debris, a cause of cerebellar MIs.Copyright © 2020 Elsevier Inc. All rights reserved.

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