Abstract
The aim of the present study was to determine whether preoperative three-dimensional (3D) fast spin-echo (FSE) T1-weighted magnetic resonance (MR) plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axial MR image slices showing the maximum plaque occupation rate (POR) and maximum plaque intensity for each patient, the contrast ratio (CR) was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC)—used to discriminate between the presence and absence of microembolic signals—was significantly greater for the CR on the axial image with maximum plaque intensity (CRmax intensity) (0.941) than for that with the maximum POR (0.885) (p < 0.05). For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA.
Highlights
Magnetic resonance (MR) plaque imaging is used to assess plaque characteristics in patients with cervical carotid stenosis
transcranial Doppler (TCD) was attempted in all participants, reliable TCD monitoring was not achieved throughout the entire operation in 12 patients because an adequate bone window could not be obtained
While the sensitivity and negative-predictive value in predicting the development of microembolic signals (MES) during carotid exposure did not differ between 3D fast spin-echo (FSE) T1-weighted imaging (WI) and 2D spin echo (SE) T1-WI, the specificity and positive-predictive value were significantly greater in the former than in the latter. These findings suggest that 3D plaque-imaging is effective for predicting the development of MES in patients undergoing carotid endarterectomy (CEA) for carotid stenosis; the findings support the hypothesis that MES do not always originate from the site with the most severe stenosis during exposure of the carotid arteries
Summary
Magnetic resonance (MR) plaque imaging is used to assess plaque characteristics in patients with cervical carotid stenosis. A significant correlation has been reported between detection of MES during exposure of the carotid arteries and the development of new ischemic lesions or neurological deficits after CEA [10,11,12,13,14,15] When solid masses such as thrombi are present on the internal carotid artery (ICA) plaque surface, they can be dislodged by manipulating the carotid arteries for exposure during CEA, resulting in the development of cerebral ischemic lesions [16]. This suggests that MES during exposure of the carotid arteries may be associated with vulnerable carotid plaques [17]; identifying plaque vulnerability preoperatively may improve risk stratification in patients eligible for CEA
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