Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging
Robert J. Feiwell,a,
Lavrentios Besmertisa,
Rajabrata Sarkara,
David A. Salonera 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.
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FIG 1. Images show interval appearance of signal hyperintensity in the left middle frontal gyrus.
A, Axial fluid-attenuated inversion recovery image obtained 15 days before surgery.
B, Axial fluid-attenuated inversion recovery image obtained 1 day after left carotid endarterectomy.
C, This finding is hyperintense on the diffusion-weighted image, consistent with acute ischemia. Note the lack of bright diffusion signal in the chronic perirolandic infarct.
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FIG 2. Digital subtraction contrast-enhanced angiograms of the left common carotid artery bifurcation. The internal carotid artery forms a 70-degree angle relative to the external carotid artery (the largest angle in the study series). By North American Symptomatic Carotid Endarterectomy Trial criteria, maximum stenosis measures 40%, located 0.6 cm beyond the bifurcation. Calcification and ulceration are also observed
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