Carotid artery stenting based on plaque characteristics using magnetic resonance plaque imaging

●Abstract● Objective: We report the usefulness of magnetic resonance (MR) plaque imaging for treatment planning of cervical carotid artery stenosis. Carotid plaque lesions that show high-signal intensity on T1 weighted black-blood magnetic resonance imaging (BB-MRI) are regarded as high risk indicators for carotid artery stenting (CAS). We believe carotid endarterectomy (CEA) should be performed in such cases. We retrospectively examined the outcome of CAS in patients with plaques assessed by BB-MRI. Methods: We electively performed CAS in 78 cases between September 2002 and March 2010. We also used BB-MRI to quantitate carotid artery stenosis, assess plaque characteristics before treatment, and evaluate the relative overall signal intensity (roSI), which we defined as the ratio of signal intensity in carotid plaques to that in sternocleidomastoid muscles. Results: The average roSI was 1.20±0.31 and markedly higher (>1.5) in 7 lesions (9.0%). Ipsilateral diffusion-weighted imaging showed that lesions were new in 23 cases (37.1%). Within 30 days after surgery, 2 patients (2.7%) experienced stroke and myocardial infarction and eventually died. Conclusions: Non-invasive preoperative MR plaque imaging is useful for screening patients with a high risk for CAS, and this screening can ensure safe outcomes after CAS. ●Key Words● carotid artery stenting, carotid endarterectomy, carotid plaques, carotid stenosis, magnetic resonance imaging

[1]  M. Kanematsu,et al.  High-Intensity Signal on Time-of-Flight Magnetic Resonance Angiography Indicates Carotid Plaques at High Risk for Cerebral Embolism During Stenting , 2011, Stroke.

[2]  T. Iwama,et al.  Embolic complications after carotid artery stenting or carotid endarterectomy are associated with tissue characteristics of carotid plaques evaluated by magnetic resonance imaging. , 2011, Atherosclerosis.

[3]  Michael D Hill,et al.  Stenting versus endarterectomy for treatment of carotid-artery stenosis. , 2010, The New England journal of medicine.

[4]  Stenting Study,et al.  Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial , 2010, The Lancet.

[5]  A. Kastrup,et al.  New Brain Lesions After Carotid Stenting Versus Carotid Endarterectomy: A Systematic Review of the Literature , 2008, Stroke.

[6]  M. Wintermark,et al.  High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques , 2008, American Journal of Neuroradiology.

[7]  Y. Watanabe,et al.  Characterization of Carotid Atherosclerosis and Detection of Soft Plaque with Use of Black-Blood MR Imaging , 2008, American Journal of Neuroradiology.

[8]  R. Cambria.  Commentary on: Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 2006;355:1660-1671. , 2007, Perspectives in vascular surgery and endovascular therapy.

[9]  Xavier Ducrocq,et al.  Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. , 2006, The New England journal of medicine.

[10]  W. Hacke,et al.  30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial , 2006, The Lancet.

[11]  P. Pattynama,et al.  Carotid plaque composition and cerebral infarction: MR imaging study. , 2005, AJNR. American journal of neuroradiology.

[12]  T. Bajwa,et al.  Protected carotid-artery stenting versus endarterectomy in high-risk patients. , 2004, The New England journal of medicine.

[13]  W S Kerwin,et al.  In Vivo Accuracy of Multispectral Magnetic Resonance Imaging for Identifying Lipid-Rich Necrotic Cores and Intraplaque Hemorrhage in Advanced Human Carotid Plaques , 2001, Circulation.

[14]  A. Yamaura,et al.  Detection of Unstable Plaques in Patients with Carotid Stenosis Using B-Mode Ultrasonography , 2000, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[15]  P. Faries,et al.  Ex vivo human carotid artery bifurcation stenting: correlation of lesion characteristics with embolic potential. , 1998, Journal of vascular surgery.

[16]  S. Glagov,et al.  Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis. , 1997, Journal of vascular surgery.

[17]  W. Couldwell,et al.  Review: Yadav JS, Wholey MH, Kuntz RE, et al: Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501, 2004 , 2005 .

[18]  T. Elatrozy,et al.  Correlates of embolic events detected by means of transcranial Doppler in patients with carotid atheroma. , 2001, Journal of vascular surgery.