Advertisement

Embolic complications after carotid artery stenting or carotid endarterectomy are associated with tissue characteristics of carotid plaques evaluated by magnetic resonance imaging

      Abstract

      Background

      Unstable carotid plaques are associated with an increased incidence of embolic complications after carotid artery stenting (CAS) or carotid endarterectomy (CEA). The aim of this study was to elucidate the relationship between the tissue components of carotid plaques and the incidence of new ipsilateral silent ischemic lesions (NISIL) after CAS or CEA.

      Methods

      We performed CAS in 56 patients and CEA in 25 patients. We also performed quantitative analyses of carotid plaque characteristics before treatment using T1 weighted black-blood magnetic resonance imaging (BB-MRI). The signal intensity ratio (SIR) was defined as the ratio of signal intensity evaluated by BB-MRI in carotid plaques to that of sternocleidomastoid muscle. According to criteria that we and other investigators previously reported, an SIR ≥ 1.25 was defined as “high”. NISIL were evaluated by diffusion-weighted imaging of MRI before and after CAS or CEA.

      Results

      In the high SIR group, the incidence of NISIL was significantly greater after CAS than after CEA (61% vs 13%, respectively, p = 0.006), whereas there were no significant difference in NISIL after the two procedures when the SIR was <1.25 (21% vs 0%). In multivariate regression analysis, the independent predictors of NISIL were CAS (p = 0.002), symptomatic stenosis (p = 0.036) and the SIR (p = 0.049).

      Conclusions

      Noninvasive quantitative tissue characterization of carotid plaques using BB-MRI is useful to determine the indication for CAS.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Yadav J.S.
        • Wholey M.H.
        • Kuntz R.E.
        • et al.
        Stenting and angioplasty with protection in patients at high risk for endarterectomy investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients.
        N Engl J Med. 2004; 351: 1493-1501
        • Brott T.G.
        • Howard 2nd, R.W.
        • Howard G.
        • et al.
        Stenting versus endarterectomy for treatment of carotid-artery stenosis.
        N Engl J Med. 2010; 363: 11-23
        • Yuan C.
        • Mitsumori L.M.
        • Ferguson M.S.
        • et al.
        In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques.
        Circulation. 2001; 104: 2051-2056
        • Saam T.
        • Ferguson M.S.
        • Yarnykh V.L.
        • et al.
        Quantitative evaluation of carotid plaque composition by in vivo MRI.
        Arterioscler Thromb Vasc Biol. 2005; 25: 234-239
        • Ohki T.
        • Marin M.L.
        • Lyon R.T.
        • et al.
        Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential.
        J Vasc Surg. 1998; 27: 463-471
        • Henry M.
        • Henry I.
        • Klonaris C.
        • et al.
        Benefits of cerebral protection during carotid stenting with the PercuSurge GuardWire system: midterm results.
        J Endovasc Ther. 2002; 9: 1-13
        • Biasi G.M.
        • Froio A.
        • Diethrich E.B.
        • et al.
        Carotid plaque echolucency increases the risk of stroke in carotid stenting: The imaging in carotid angioplasty and risk of stroke (ICAROS) study.
        Circulation. 2004; 110: 756-762
        • Tegos T.J.
        • Sabetai M.M.
        • Nicolaides A.N.
        • et al.
        Correlates of embolic events detected by means of transcranial Doppler in patients with carotid atheroma.
        J Vasc Surg. 2001; 33: 131-138
        • North American Symptomatic Carotid Endarterectomy Trial Collaborators
        Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.
        N Engl J Med. 1991; 325: 445-453
        • Yamada K.
        • Kawasaki M.
        • Yoshimura S.
        • et al.
        Prediction of silent ischemic lesions after carotid stenting using integrated backscatter ultrasound and magnetic resonance imaging.
        Atherosclerosis. 2010; 208: 161-166
        • Yoshida K.
        • Narumi O.
        • Chin M.
        • et al.
        Characterization of carotid atherosclerosis and detection of soft plaque with use of black-blood MR imaging.
        AJNR Am J Neuroradiol. 2008; 29: 868-874
        • Schluter M.
        • Tubler T.
        • Steffens J.C.
        • et al.
        Focal ischemia of the brain after neuroprotected Carotid artery stenting.
        J Am Coll Cardiol. 2003; 42: 1007-1013
        • Hammer F.D.
        • Lacroix V.
        • Duprez T.
        • et al.
        Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2-year prospective study.
        J Vasc Surg. 2005; 42: 847-853
        • Flach H.Z.
        • Ouhlous M.
        • Hendriks J.M.
        • et al.
        Cerebral ischemia after carotid intervention.
        J Endvasc Ther. 2004; 11: 251-257
        • Tomczak R.
        • Wunderlich A.
        • Liewald F.
        • et al.
        Diffusion-weighted MRI: detection of cerebral ischemia before and after carotid thromboendarterectomy.
        J Comput Assist Tomogr. 2001; 25: 247-250
        • Lacroix V.
        • Hammer F.D.
        • Astarci P.
        • et al.
        Ischemic cerebral lesions after carotid surgery and carotid stenting.
        Eur J Vasc Endovasc Surg. 2007; 33: 135-141
        • Poppert H.
        • Wolf O.
        • Resch M.
        • et al.
        Differences in number, size and location of intracranial microembolic lesions after surgical versus endovascular treatment without protection device of carotid artery stenosis.
        J Neurol. 2004; 251: 1198-1203
        • Schnaudigel S.
        • Groschel K.
        • Pilgram S.M.
        • Kastrup A.
        New brain lesion after carotid stenting versus carotid endarterectomy: a systematic review of the literature.
        Stroke. 2008; 39: 1911-1919
        • Kastrup A.
        • Nagele T.
        • Groschel K.
        • et al.
        Incidence of new brain lesions after carotid stenting with and without cerebral protection.
        Stroke. 2006; 37: 2312-2316
        • Spagnoli L.G.
        • Mauriello A.
        • Sangiorgi G.
        • et al.
        Extracranial thrombotically active carotid plaque as a risk factor for ischemic stroke.
        JAMA. 2004; 292: 1845-1852
        • Wholey M.H.
        • Al-Mubarek N.
        Updated review of the global carotid artery stent registry.
        Catheter Cardiovasc Interv. 2003; 60: 259-266