High-Intensity Signal on Time-of-Flight Magnetic Resonance Angiography Indicates Carotid Plaques at High Risk for Cerebral Embolism During Stenting

• Published in: Stroke (1970) Vol. 42; no. 11; pp. 3132 - 3137
• Main Authors: YOSHIMURA, Shinichi, YAMADA, Kiyofumi, KAWASAKI, Masanori, ASANO, Takahiko, KANEMATSU, Masayuki, TAKAMATSU, Manabu, HARA, Akira, IWAMA, Toru
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-11-2011
• Subjects: Aged; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Female; Humans; Intracranial Embolism - diagnostic imaging; Intracranial Embolism - etiology; Intraoperative Complications - diagnostic imaging; Intraoperative Complications - etiology; Magnetic Resonance Angiography - methods; Male; Medical sciences; Middle Aged; Neurology; Radiography; Retrospective Studies; Risk Factors; Stents - adverse effects; Vascular diseases and vascular malformations of the nervous system; Carotid stenosis; Stroke; Nervous system diseases; risk factors; High intensity; Cerebral embolism; Cardiovascular disease; Cerebral disorder; stenting; Arterial disease; Vascular disease; Time of flight method; Carotid; Central nervous system disease; Risk factor; carotid endarterectomy; NMR angiography; Endarteriectomy; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/strokeaha.111.615708

A major disadvantage of carotid artery stenting (CAS) compared to carotid endarterectomy is the increased risk of cerebral embolism. Thus, establishing a simple method to discriminate fragile plaques on preoperative routine examination is important. The present study examined whether high-intensity signal (HIS) in the plaque on time-of-flight (TOF) MRA, performed for screening, can discriminate plaque at high risk for cerebral embolism during CAS.
In the 30 patients treated using carotid endarterectomy, relationships between pathological findings of the plaques and TOF-MRA findings were analyzed. In the 112 patients treated using CAS, postoperative ipsilateral ischemic lesions on diffusion-weighted imaging and periprocedural ischemic symptoms were analyzed.
The percentage area of intraplaque hemorrhage stained by glycophorin A was significantly larger in HIS-positive plaques (51.8%±9.8%) than in HIS-negative plaques (8.6%±9.4%; P<0.001). Postoperative ischemic lesions on diffusion-weighted imaging were more frequent in the HIS-positive plaques (25/38; 65.8%) than in the HIS-negative plaques (26/74; 35.1%; P=0.002). Periprocedural ischemic symptoms were more frequently observed in HIS-positive plaques (7/38; 18.4%) than in HIS-negative plaques (1/74; 1.4%; P=0.003). Multivariate logistic regression analysis identified HIS on TOF-MRA as an independent predictor of periprocedural ischemic symptoms (odds ratio, 15.08; 95% confidence interval, 1.76-129.0).
HIS in the plaque on TOF-MRA performed for screening could discriminate plaques at high risk for cerebral embolism during CAS.