Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Feiwell, R. J. Articles by Rapp, J. H. Search for Related Content PubMed PubMed Citation Articles by Feiwell, R. J. Articles by Rapp, J. H.

American Journal of Neuroradiology 22:646-649 (4 2001)
© 2001 American Society of Neuroradiology

ARTICLE

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

Robert J. Feiwell^,a, Lavrentios Besmertis^a, Rajabrata Sarkar^a, David A. Saloner^a and Joseph H. Rapp^,a

^a From theDepartments of Radiology (R.J.F., D.A.S.), Neurology (L.B.), and Vascular Surgery (R.S., J.H.R.), University of California, San Francisco, and the San Francisco Veterans Administration Medical Center (R.S., D.A.S., J.H.R.), San Francisco, CA.

BACKGROUND AND PURPOSE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

This article has been cited by other articles:

				J. Schofer, M. Arendt, T. Tubler, J. Sandstede, and M. Schluter Late Cerebral Embolization After Emboli-Protected Carotid Artery Stenting Assessed by Sequential Diffusion-Weighted Magnetic Resonance Imaging J. Am. Coll. Cardiol. Intv., October 1, 2008; 1(5): 571 - 577. [Abstract] [Full Text] [PDF]

				S. Schnaudigel, K. Groschel, S. M. Pilgram, and A. Kastrup New Brain Lesions After Carotid Stenting Versus Carotid Endarterectomy: A Systematic Review of the Literature Stroke, June 1, 2008; 39(6): 1911 - 1919. [Abstract] [Full Text] [PDF]

				B. K. Lal Cognitive Function After Carotid Artery Revascularization Vascular and Endovascular Surgery, February 1, 2007; 41(1): 5 - 13. [Abstract] [PDF]

				G. Maleux, P. Demaerel, E. Verbeken, K. Daenens, S. Heye, F. Van Sonhoven, A. Nevelsteen, and G. Wilms Cerebral ischemia after filter-protected carotid artery stenting is common and cannot be predicted by the presence of substantial amount of debris captured by the filter device. AJNR Am. J. Neuroradiol., October 1, 2006; 27(9): 1830 - 1833. [Abstract] [Full Text] [PDF]

				F. Asakura, K. Kawaguchi, H. Sakaida, N. Toma, S. Matsushima, K. Kuraishi, H. Tanemura, Y. Miura, M. Maeda, and W. Taki Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 753 - 758. [Abstract] [Full Text] [PDF]

				H. G. Roh, H. S. Byun, J. W. Ryoo, D. G. Na, W.-J. Moon, B. B. Lee, and D.-I. Kim Prospective Analysis of Cerebral Infarction After Carotid Endarterectomy and Carotid Artery Stent Placement by Using Diffusion-Weighted Imaging AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 376 - 384. [Abstract] [Full Text] [PDF]

				L. Soinne, J. Helenius, E. Saimanen, O. Salonen, P. J. Lindsberg, M. Kaste, and T. Tatlisumak Brain diffusion changes in carotid occlusive disease treated with endarterectomy Neurology, October 28, 2003; 61(8): 1061 - 1065. [Abstract] [Full Text] [PDF]

				H. P. M. van Heesewijk, J. A. Vos, E. S. Louwerse, J. C. van den Berg, T. T. C. Overtoom, S. M. P. G. Ernst, H. W. Mauser, F. L. Moll, and R. G. A. Ackerstaff New Brain Lesions at MR Imaging after Carotid Angioplasty and Stent Placement Radiology, August 1, 2002; 224(2): 361 - 365. [Abstract] [Full Text] [PDF]