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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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| Published in: | American journal of neuroradiology 2001-04, Vol.22 (4), p.646-649 |
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| container_title | American journal of neuroradiology |
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| creator | Feiwell, Robert J Besmertis, Lavrentios Sarkar, Rajabrata Saloner, David A Rapp, Joseph H |
| description | 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 |
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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 <1 cm in diameter, ipsilateral to the CEA. The postoperative neurologic examination showed no change in status from the preoperative baseline state. This patient had an intraoperative course complicated by the development of a large luminal thrombus, necessitating thrombectomy.
The use of diffusion-weighted imaging may serve to improve conspicuity of clinically silent infarcts after CEA. An important next step is to determine the risk factors that predispose to detectable parenchymal ischemic events.</description><identifier>ISSN: 0195-6108</identifier><identifier>EISSN: 1936-959X</identifier><identifier>PMID: 11290471</identifier><identifier>CODEN: AAJNDL</identifier><language>eng</language><publisher>Oak Brook, IL: Am Soc Neuroradiology</publisher><subject>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</subject><ispartof>American journal of neuroradiology, 2001-04, Vol.22 (4), p.646-649</ispartof><rights>2001 INIST-CNRS</rights><rights>Copyright © American Society of Neuroradiology 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976011/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976011/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,309,310,314,727,780,784,789,790,885,23929,23930,25139,53790,53792</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=962015$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11290471$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feiwell, Robert J</creatorcontrib><creatorcontrib>Besmertis, Lavrentios</creatorcontrib><creatorcontrib>Sarkar, Rajabrata</creatorcontrib><creatorcontrib>Saloner, David A</creatorcontrib><creatorcontrib>Rapp, Joseph H</creatorcontrib><title>Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging</title><title>American journal of neuroradiology</title><addtitle>AJNR Am J Neuroradiol</addtitle><description>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 <1 cm in diameter, ipsilateral to the CEA. The postoperative neurologic examination showed no change in status from the preoperative baseline state. This patient had an intraoperative course complicated by the development of a large luminal thrombus, necessitating thrombectomy.
The use of diffusion-weighted imaging may serve to improve conspicuity of clinically silent infarcts after CEA. An important next step is to determine the risk factors that predispose to detectable parenchymal ischemic events.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain</subject><subject>Cerebral Cortex - pathology</subject><subject>Cerebral Infarction - diagnosis</subject><subject>Diffusion</subject><subject>Endarterectomy, Carotid</subject><subject>Humans</subject><subject>Image Enhancement</subject><subject>Image Processing, Computer-Assisted</subject><subject>Infarction, Middle Cerebral Artery - diagnosis</subject><subject>Intracranial Embolism - diagnosis</subject><subject>Intraoperative Complications - diagnosis</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Middle Cerebral Artery - pathology</subject><subject>Neurologic Examination</subject><subject>Neurology</subject><subject>Postoperative Complications - diagnosis</subject><subject>Sensitivity and Specificity</subject><subject>Ultrasonography, Doppler, Transcranial</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0195-6108</issn><issn>1936-959X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><recordid>eNpVkV1LwzAUhosobk7_ggRE7wr5aJPmRpBt6mDghQ68C1mTbJE2nUlm2b83sjn0KnDOk-ecvDnJhogTmvOSv59mQ4h4mVMEq0F2EcIHhLDkDJ9nA4QwhwVDw8xOdNR1tJ0DnQHjxjpby6bZgVfbaBfBzBnp6xiANFF7MJa-i1aBqVPSp0K62rU7sNyBRdA_hok1ZhuSLu-1Xa2jVmDWypV1q8vszMgm6KvDOcoWj9O38XM-f3majR_m-ZpgGHMJJYaQ1lVhKmIKoirGKWdVUTJMSNoaaQUlUUgxVJnlkmBc4pqzgiBV6JKTUXa_9262y1arOr3Cy0ZsvG2l34lOWvG_4-xarLovwTijEKEkuDsIfPe51SGK1oZaN410utsGwRjEvKQwgdd_Jx1H_KabgJsDIENK1XjpahuOHKcYojJRt3tqnQLrrdcitOkLkhSJvu8xFoWgBSXfWt-R3A</recordid><startdate>20010401</startdate><enddate>20010401</enddate><creator>Feiwell, Robert J</creator><creator>Besmertis, Lavrentios</creator><creator>Sarkar, Rajabrata</creator><creator>Saloner, David A</creator><creator>Rapp, Joseph H</creator><general>Am Soc Neuroradiology</general><general>American Society of Neuroradiology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20010401</creationdate><title>Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging</title><author>Feiwell, Robert J ; Besmertis, Lavrentios ; Sarkar, Rajabrata ; Saloner, David A ; Rapp, Joseph H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h320t-a0a2006c84f83f43d87969784572339041ed0a3d1d718fbb32252c97431d4e593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Brain</topic><topic>Cerebral Cortex - pathology</topic><topic>Cerebral Infarction - diagnosis</topic><topic>Diffusion</topic><topic>Endarterectomy, Carotid</topic><topic>Humans</topic><topic>Image Enhancement</topic><topic>Image Processing, Computer-Assisted</topic><topic>Infarction, Middle Cerebral Artery - diagnosis</topic><topic>Intracranial Embolism - diagnosis</topic><topic>Intraoperative Complications - diagnosis</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Middle Cerebral Artery - pathology</topic><topic>Neurologic Examination</topic><topic>Neurology</topic><topic>Postoperative Complications - diagnosis</topic><topic>Sensitivity and Specificity</topic><topic>Ultrasonography, Doppler, Transcranial</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feiwell, Robert J</creatorcontrib><creatorcontrib>Besmertis, Lavrentios</creatorcontrib><creatorcontrib>Sarkar, Rajabrata</creatorcontrib><creatorcontrib>Saloner, David A</creatorcontrib><creatorcontrib>Rapp, Joseph H</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of neuroradiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feiwell, Robert J</au><au>Besmertis, Lavrentios</au><au>Sarkar, Rajabrata</au><au>Saloner, David A</au><au>Rapp, Joseph H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging</atitle><jtitle>American journal of neuroradiology</jtitle><addtitle>AJNR Am J Neuroradiol</addtitle><date>2001-04-01</date><risdate>2001</risdate><volume>22</volume><issue>4</issue><spage>646</spage><epage>649</epage><pages>646-649</pages><issn>0195-6108</issn><eissn>1936-959X</eissn><coden>AAJNDL</coden><abstract>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 <1 cm in diameter, ipsilateral to the CEA. The postoperative neurologic examination showed no change in status from the preoperative baseline state. This patient had an intraoperative course complicated by the development of a large luminal thrombus, necessitating thrombectomy.
The use of diffusion-weighted imaging may serve to improve conspicuity of clinically silent infarcts after CEA. An important next step is to determine the risk factors that predispose to detectable parenchymal ischemic events.</abstract><cop>Oak Brook, IL</cop><pub>Am Soc Neuroradiology</pub><pmid>11290471</pmid><tpages>4</tpages></addata></record> |
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| 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 |
| title | Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging |
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