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The restoring of interhemispheric brain connectivity following carotid endarterectomy: an exploratory observational study

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Abstract

This study aimed to evaluate the differences of brain connectivity between healthy subjects (HS) and patients with extracranial internal carotid artery (eICA) stenosis before and after carotid endarterectomy (CEA). An exploratory prospective study was designed. The study population consisted of a patient group (PG) of 20 patients with eICA stenosis eligible for CEA, and a control group (CG) of 20 HS, matched for age and sex. The subjects of the PG group underwent Magnetic Resonance Imaging (MRI) for resting-state functional connectivity MRI (rs-fc MRI) analysis within one week from the CEA (pre-CEA) and 12 months following CEA (post-CEA). The CG underwent a single MRI with the same protocol utilized for the PG. Three region-of-interest to region-of-interest (ROI-to-ROI) rs-fc MRI analyses were conducted: analysis 1 to compare pre-CEA PG and CG; analysis 2 to compare pre-CEA PG and post-CEA PG; analysis 3 to compare post-CEA PG and CG. The Functional Network Connectivity multivariate parametric technique was used for statistical analysis, adopting a p-uncorrected (p-unc) < 0.05 as connection threshold, and a cluster level False Discovery Rate corrected p (p-FDR) < 0.05 as cluster threshold. The clusters were defined by using a data-driven hierarchical clustering procedure. Analysis 1 revealed two clusters of reduced interhemispheric connectivity of pre-CEA PG when compared to CG. Analysis 2 and 3 showed no statistically significant differences. Our exploratory analysis suggests that patients with eICA stenosis have reduced interhemispheric connectivity when compared to a matched control group, and this difference was not evident anymore following endarterectomy.

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Data availability

Raw imaging data cannot be shared due to institutional policies. Additional information on processing pipelines may be requested from the corresponding author.

Abbreviations

AAL:

Automated anatomical labelling

ALFF:

Amplitude of low frequency fluctuations

BOLD:

Blood oxygen level dependent

CAS:

Carotid stenting

CEA:

Carotid endarterectomy

CSF:

Cerebrospinal fluid

CRV:

Cerebrovascular reactivity

CTA:

Computed tomography angiography

DWI:

Diffusion weighted imaging

EEG:

Electroencephalografy

eICA:

Extracranial internal carotid artery stenosis

EPI:

Echo-planar imaging

ESC:

European Society of Cardiology

GLM:

General linear model

GM:

Grey matter

HRF:

Hemodynamic Response Function

HS:

Healthy subjects

ICA:

Internal carotid artery

IMT:

Intima-media thickness

MMSE:

Mini-mental state examination

MNI:

Montreal Neurological Institute

MRI:

Magnetic resonance imaging

NASCET:

North American Symptomatic Carotid Endarterectomy Trial

p-FDR:

p-value corrected for false discovery rate

p-unc:

Uncorrected p-value

PG:

Patient group

ROI-to-ROI:

Region of Interest to Region of Interest

rs-fMRI:

Resting-state functional magnetic resonance imaging

rs-fc MRI:

Resting-state functional connectivity MRI

T1-W:

T1 weighted

T2-W:

T2 weighted

TFE:

Turbo Field Echo

TIA:

Transient ischemic attack

US:

Ultrasound

VCI:

Vascular Cognitive Impairment

WM:

White matter

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Authors and Affiliations

  1. Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy

    Michele Porcu, Luigi Cocco, Riccardo Cau & Luca Saba

  2. Department of Medical Imaging, Azienda Ospedaliera Universitaria Di Cagliari, S.S: 554, km 4,500, Monserrato, CAP: 09042, Cagliari, Italy

    Michele Porcu

  3. Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA

    Jasjit S. Suri

  4. Department of Neuroradiology, Stanford University, Stanford, CA, USA

    Max Wintermark

  5. Department of Radiology (IDI) and Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain

    Josep Puig

  6. Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China

    Yang Qi

  7. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Giuseppe Lanzino

  8. Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio”, Chieti, Italy

    Massimo Caulo

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  1. Michele Porcu
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Contributions

Study design, M.P., L.C.; Methodology M.P., L.C.; Validation M.P., L.C., L.S.; Data Curation M.P., R.C.; Investigation M.P.; Writing – Original Draft, M.P., L.C.; Writing – Review and Editing, L.S., J.S.S., G.L., M.W., J.P., M.C.; Supervision, L.S., M.C., M.W.

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Correspondence to Michele Porcu.

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Michele Porcu and Luigi Cocco contributed equally: co-first authors.

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Porcu, M., Cocco, L., Cau, R. et al. The restoring of interhemispheric brain connectivity following carotid endarterectomy: an exploratory observational study. Brain Imaging and Behavior 16, 2037–2048 (2022). https://doi.org/10.1007/s11682-022-00674-1

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