Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging

Intraprocedural transcranial Doppler sonography has identified multiple microembolic events during and immediately after carotid endarterectomy (CEA) or angioplasty, yet the rate of clinically evident stroke is small. To determine the significance of the transcranial Doppler sonography findings, we...

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Bibliographic Details
Published in:American journal of neuroradiology 2001-04, Vol.22 (4), p.646-649
Main Authors: Feiwell, Robert J, Besmertis, Lavrentios, Sarkar, Rajabrata, Saloner, David A, Rapp, Joseph H
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Brain
Cerebral Cortex - pathology
Cerebral Infarction - diagnosis
Diffusion
Endarterectomy, Carotid
Humans
Image Enhancement
Image Processing, Computer-Assisted
Infarction, Middle Cerebral Artery - diagnosis
Intracranial Embolism - diagnosis
Intraoperative Complications - diagnosis
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Middle Cerebral Artery - pathology
Neurologic Examination
Neurology
Postoperative Complications - diagnosis
Sensitivity and Specificity
Ultrasonography, Doppler, Transcranial
Vascular diseases and vascular malformations of the nervous system
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Summary:Intraprocedural transcranial Doppler sonography has identified multiple microembolic events during and immediately after carotid endarterectomy (CEA) or angioplasty, yet the rate of clinically evident stroke is small. To determine the significance of the transcranial Doppler sonography findings, we examined patients by use of diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging before and immediately after CEA for evidence of clinically silent ischemic events. Twenty-five patients with atherosclerotic disease of the carotid arteries underwent diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging performed, on average, 3 days before and 12 hours after CEA. Diffusion-weighted images were acquired in three orthogonal directions at b = 900. Pre- and postoperative neurologic examinations were performed by the same physician. After endarterectomy, 4.0% of the patients (one of 25 patients) showed a single, cortical focus of restricted diffusion and new fluid-attenuated inversion recovery hyperintensity, measuring
ISSN:0195-6108
1936-959X