High-Risk Plaque for Carotid Artery Stenting Evaluated With 3-Dimensional T1-Weighted Gradient Echo Sequence

• Published in: Stroke (1970) 2013, Vol.44 (1), p.105-110
• Main Authors: TANEMURA, Hiroshi, MAEDA, Masayuki, MATSUSHIMA, Satoshi, TAKI, Waro, ICHIKAWA, Naoki, MIURA, Yoichi, UMEDA, Yasuyuki, HATAZAKI, Seiji, TOMA, Naoki, ASAKURA, Fumio, SUZUKI, Hidenori, SAKAIDA, Hiroshi
• Format: Article
• Language: English
• Subjects: Aged; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Arteries - pathology; Carotid Arteries - surgery; Carotid Stenosis - pathology; Carotid Stenosis - surgery; Diffusion Magnetic Resonance Imaging - methods; Echo-Planar Imaging - methods; Female; Humans; Imaging, Three-Dimensional - methods; Male; Medical sciences; Neurology; Plaque, Atherosclerotic - pathology; Plaque, Atherosclerotic - surgery; Retrospective Studies; Risk Factors; Stents - adverse effects; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.112.663138

Preventing cerebral embolisms is a major concern with carotid artery stenting (CAS). This study evaluated 3-dimensional T1-weighted gradient echo (3D T1GRE) sequence to predict cerebral embolism related to CAS. We performed quantitative analyses of the characteristics of 47 carotid plaques before CAS by measuring the signal intensity ratio (SIR) and plaque volume using 3D T1GRE images. We used T1-weighted turbo field echo sequence to obtain 3D T1GRE images. We also evaluated diffusion-weighted images (DWI) of the brain before and after CAS to detect ischemic lesions (DWI lesions) from cerebral emboli. SIR (2.17 [interquartile range 1.50-3.07] versus 1.35 [interquartile range 1.08-1.97]; P=0.010) and plaque volume (456 mm(3) [interquartile range 256-696] versus 301 mm(3) [interquartile range 126-433]; P=0.008) were significantly higher in the group of patients positive for DWI lesions (P-group: n=26) than DWI lesion-negative patients (N-group: n=21). In multivariate logistic regression analysis, SIR (P=0.007) and plaque volume (P=0.042) were independent predictors of DWI lesions with CAS. Furthermore, SIR (rs=0.42, P=0.005) and plaque volume (rs=0.36, P=0.012) were positively correlated with the number of DWI lesions. From analysis of a receiver-operating characteristic curve, the most reliable cutoff values of SIR and plaque volume to predict DWI lesions related to CAS were 1.80 and 373 mm(3), respectively. Quantitative evaluation of carotid plaques using 3D T1GRE images may be useful in predicting cerebral embolism related to CAS.