Advertisement

Associations between carotid intraplaque hemorrhage and new ipsilateral ischemic lesions after carotid artery stenting: a quantitative study with conventional multi-contrast MRI

  • Aihua Ji
  • Peng Lv
  • Yuanyuan Dai
  • Xueqin Bai
  • Xiao Tang
  • Caixia Fu
  • Jiang LinEmail author
Original Paper
  • 48 Downloads

Abstract

The risk of cerebral embolism after CAS in patients with carotid IPH is still controversial. This study was to further investigate the relationship between IPH and new ipsilateral ischemic lesion (NIIL) after CAS, and to perform a volumetric analysis of IPH for predicting the risk of NIIL following CAS. One hundred and seventeen patients with carotid stenosis undergoing CAS were prospectively enrolled. Preprocedural multi-contrast carotid MRI was performed. NIIL was evaluated by brain DWI before and after CAS. IPH volume, wall volume at the plaque (WVplaque) and relative IPH volume were calculated. Associations between IPH and postprocedural NIIL were studied. NIILs were shown in 52 patients. IPH were identified in 53 patients. NIILs were found more frequently in IPH-positive (33/53, 62.3%) than in IPH-negative patients (19/64, 29.7%, p < 0.001). There was no significant difference of WVplaque between NIIL-positive and NIIL-negative patients (1166.6 ± 432.0 mm3 vs 1124.6 ± 410.4 mm3, p = 0.592). The IPH volume from NIIL-positive group was significantly larger than that of NIIL-negative group (252.8 ± 264.9 mm3 vs 59.3 ± 131.1 mm3, p < 0.001), with also higher relative IPH volume (20.4 ± 19.1% vs 5.7 ± 12.2%, p < 0.001). ROC curve showed that 183.45 mm3 of the IPH volume was the most reliable cutoff value for predicting NIIL with a specificity of 92.3% and a positive predictive value of 86.1%. Larger IPH volume is associated with increased risk of NIIL after CAS procedure. Quantification of IPH volume may be useful for predicting cerebral ischemic events after CAS.

Keywords

New ipsilateral ischemic lesions Carotid artery stenting Intraplaque hemorrhage volume Carotid plaque 

Abbreviations

CAS

Carotid artery stenting

CEA

Carotid endarterectomy

CI

Confidence interval

IPH

Intraplaque hemorrhage

NIIL

New ipsilateral ischemic lesion

ROC

Receiver operating characteristic

TOF

Time-of-flight

WV

Wall volume

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Akutsu N, Hosoda K, Fujita A, Kohmura E (2012) A preliminary prediction model with MR plaque imaging to estimate risk for new ischemic brain lesions on diffusion-weighted imaging after endarterectomy or stenting in patients with carotid stenosis. AJNR Am J Neuroradiol 33:1557–1564CrossRefGoogle Scholar
  2. 2.
    Liakishev AA (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. Results of SAPPHIRE trial. Kardiologiia 44:76–76Google Scholar
  3. 3.
    Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG, Investigators C (2010) The Carotid Revascularization endarterectomy versus stenting trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke 41:S31–S34CrossRefGoogle Scholar
  4. 4.
    Schnaudigel S, Groschel K, Pilgram SM, Kastrup A (2008) New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 39:1911–1919CrossRefGoogle Scholar
  5. 5.
    Capodanno D, Gargiulo G, Sannino A et al (2015) New cerebral lesions at magnetic resonance imaging after carotid artery stenting versus endarterectomy: an updated meta-analysis. PloS ONE 10:e0129209CrossRefGoogle Scholar
  6. 6.
    Cho SM, Deshpande A, Pasupuleti P et al (2017) Radiographic and symptomatic brain ischemia in CEA and CAS: a systematic review and meta-analysis. Neurology 89:1977–1984CrossRefGoogle Scholar
  7. 7.
    Gensicke H, van der Worp HB, Nederkoorn PJ et al (2015) Ischemic brain lesions after carotid artery stenting increase future cerebrovascular risk. J Am Coll Cardiol 65:521–529CrossRefGoogle Scholar
  8. 8.
    Gupta A, Giambrone AE, Gialdini G et al (2016) Silent brain infarction and risk of future stroke: a systematic review and meta-analysis. Stroke 47:719–725CrossRefGoogle Scholar
  9. 9.
    Fukumitsu R, Yoshida K, Kurosaki Y et al (2017) Short-term results of carotid endarterectomy and stenting after the introduction of carotid magnetic resonance imaging: a single-institution eetrospective study. World Neurosurg 101:308–314CrossRefGoogle Scholar
  10. 10.
    Yamada K, Kawasaki M, Yoshimura S et al (2010) Prediction of silent ischemic lesions after carotid artery stenting using integrated backscatter ultrasound and magnetic resonance imaging. Atherosclerosis 208:161–166CrossRefGoogle Scholar
  11. 11.
    Yamada K, Yoshimura S, Kawasaki M et al (2011) Embolic complications after carotid artery stenting or carotid endarterectomy are associated with tissue characteristics of carotid plaques evaluated by magnetic resonance imaging. Atherosclerosis 215:399–404CrossRefGoogle Scholar
  12. 12.
    Yoshimura S, Yamada K, Kawasaki M et al (2011) High-Intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting. Stroke 42:3132–3137CrossRefGoogle Scholar
  13. 13.
    Chung GH, Jeong JY, Kwak HS, Hwang SB (2016) Associations between cerebral embolism and carotid intraplaque hemorrhage during protected carotid artery stenting. AJNR Am J Neuroradiol 37:686–691CrossRefGoogle Scholar
  14. 14.
    Yoon W, Kim SK, Park MS, Chae HJ, Kang HK (2012) Safety of protected carotid artery stenting in patients with severe carotid artery stenosis and carotid intraplaque hemorrhage. AJNR Am J Neuroradiol 33:1027–1031CrossRefGoogle Scholar
  15. 15.
    Barnett HJM, Taylor DW, Haynes RB et al (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453CrossRefGoogle Scholar
  16. 16.
    Lanzino G, Rabinstein AA, Brown RD (2009) Treatment of carotid artery stenosis: medical therapy, surgery, or stenting? Mayo Clin Proc 84:362–387CrossRefGoogle Scholar
  17. 17.
    Chu B, Kampschulte A, Ferguson MS et al (2004) Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke 35:1079–1084CrossRefGoogle Scholar
  18. 18.
    Kampschulte A, Ferguson MS, Kerwin WS et al (2004) Differentiation of intraplaque versus juxtaluminal hemorrhage/thrombus in advanced human carotid atherosclerotic lesions by in vivo magnetic resonance imaging. Circulation 110:3239–3244CrossRefGoogle Scholar
  19. 19.
    Cai JM, Hastukami TS, Ferguson MS, Small R, Polissar NL, Yuan C (2002) Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation 106:1368–1373CrossRefGoogle Scholar
  20. 20.
    Lokuge K, de Waard DD, Halliday A, Gray A, Bulbulia R, Mihaylova B (2018) Meta-analysis of the procedural risks of carotid endarterectomy and carotid artery stenting over time. Br J Surg 105:26–36CrossRefGoogle Scholar
  21. 21.
    Schillinger M, Gschwendtner M, Reimers B et al (2008) Does carotid stent cell design matter? Stroke 39:905–909CrossRefGoogle Scholar
  22. 22.
    Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G (2016) Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg 124:27–42CrossRefGoogle Scholar
  23. 23.
    Takaya N, Yuan C, Chu B et al (2005) Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation 111:2768–2775CrossRefGoogle Scholar
  24. 24.
    Redgrave JN, Lovett JK, Gallagher PJ, Rothwell PM (2006) Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the Oxford plaque study. Circulation 113:2320–2328CrossRefGoogle Scholar
  25. 25.
    Verhoeven B, Hellings WE, Moll FL et al (2005) Carotid atherosclerotic plaques in patients with transient ischemic attacks and stroke have unstable characteristics compared with plaques in asymptomatic and amaurosis fugax patients. J Vasc Surg 42:1075–1081CrossRefGoogle Scholar
  26. 26.
    Yoshimura S, Yamada K, Kawasaki M et al (2013) Selection of carotid artery stenting or endarterectomy based on magnetic resonance plaque imaging reduced periprocedural adverse events. J Stroke Cerebrovasc Dis 22:1082–1087CrossRefGoogle Scholar
  27. 27.
    Albuquerque LC, Narvaes LB, Maciel AA et al (2007) Intraplaque hemorrhage assessed by high-resolution magnetic resonance imaging and C-reactive protein in carotid atherosclerosis. J Vasc Surg 46:1130–1137CrossRefGoogle Scholar
  28. 28.
    Bitar R, Moody AR, Leung G et al (2008) In vivo 3D high-spatial-resolution MR imaging of intraplaque hemorrhage. Radiology 249:259–267CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Radiology, Zhongshan HospitalFudan University and Shanghai Institute of Medical ImagingShanghaiChina
  2. 2.Department of Vascular Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
  3. 3.Siemens Shenzhen Magnetic Resonance LtdShenzhenChina

Personalised recommendations