Skip to main content

Advertisement

SpringerLink
Log in

Associations between carotid intraplaque hemorrhage and new ipsilateral ischemic lesions after carotid artery stenting: a quantitative study with conventional multi-contrast MRI

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The risk of cerebral embolism after CAS in patients with carotid IPH is still controversial. This study was to further investigate the relationship between IPH and new ipsilateral ischemic lesion (NIIL) after CAS, and to perform a volumetric analysis of IPH for predicting the risk of NIIL following CAS. One hundred and seventeen patients with carotid stenosis undergoing CAS were prospectively enrolled. Preprocedural multi-contrast carotid MRI was performed. NIIL was evaluated by brain DWI before and after CAS. IPH volume, wall volume at the plaque (WVplaque) and relative IPH volume were calculated. Associations between IPH and postprocedural NIIL were studied. NIILs were shown in 52 patients. IPH were identified in 53 patients. NIILs were found more frequently in IPH-positive (33/53, 62.3%) than in IPH-negative patients (19/64, 29.7%, p < 0.001). There was no significant difference of WVplaque between NIIL-positive and NIIL-negative patients (1166.6 ± 432.0 mm3 vs 1124.6 ± 410.4 mm3, p = 0.592). The IPH volume from NIIL-positive group was significantly larger than that of NIIL-negative group (252.8 ± 264.9 mm3 vs 59.3 ± 131.1 mm3, p < 0.001), with also higher relative IPH volume (20.4 ± 19.1% vs 5.7 ± 12.2%, p < 0.001). ROC curve showed that 183.45 mm3 of the IPH volume was the most reliable cutoff value for predicting NIIL with a specificity of 92.3% and a positive predictive value of 86.1%. Larger IPH volume is associated with increased risk of NIIL after CAS procedure. Quantification of IPH volume may be useful for predicting cerebral ischemic events after CAS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

CAS:

Carotid artery stenting

CEA:

Carotid endarterectomy

CI:

Confidence interval

IPH:

Intraplaque hemorrhage

NIIL:

New ipsilateral ischemic lesion

ROC:

Receiver operating characteristic

TOF:

Time-of-flight

WV:

Wall volume

References

  1. Akutsu N, Hosoda K, Fujita A, Kohmura E (2012) A preliminary prediction model with MR plaque imaging to estimate risk for new ischemic brain lesions on diffusion-weighted imaging after endarterectomy or stenting in patients with carotid stenosis. AJNR Am J Neuroradiol 33:1557–1564

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Liakishev AA (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. Results of SAPPHIRE trial. Kardiologiia 44:76–76

    CAS  PubMed  Google Scholar 

  3. Mantese VA, Timaran CH, Chiu D, Begg RJ, Brott TG, Investigators C (2010) The Carotid Revascularization endarterectomy versus stenting trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke 41:S31–S34

    Article  PubMed  PubMed Central  Google Scholar 

  4. Schnaudigel S, Groschel K, Pilgram SM, Kastrup A (2008) New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 39:1911–1919

    Article  PubMed  Google Scholar 

  5. Capodanno D, Gargiulo G, Sannino A et al (2015) New cerebral lesions at magnetic resonance imaging after carotid artery stenting versus endarterectomy: an updated meta-analysis. PloS ONE 10:e0129209

    Article  CAS  Google Scholar 

  6. Cho SM, Deshpande A, Pasupuleti P et al (2017) Radiographic and symptomatic brain ischemia in CEA and CAS: a systematic review and meta-analysis. Neurology 89:1977–1984

    Article  PubMed  Google Scholar 

  7. Gensicke H, van der Worp HB, Nederkoorn PJ et al (2015) Ischemic brain lesions after carotid artery stenting increase future cerebrovascular risk. J Am Coll Cardiol 65:521–529

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gupta A, Giambrone AE, Gialdini G et al (2016) Silent brain infarction and risk of future stroke: a systematic review and meta-analysis. Stroke 47:719–725

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Fukumitsu R, Yoshida K, Kurosaki Y et al (2017) Short-term results of carotid endarterectomy and stenting after the introduction of carotid magnetic resonance imaging: a single-institution eetrospective study. World Neurosurg 101:308–314

    Article  PubMed  Google Scholar 

  10. Yamada K, Kawasaki M, Yoshimura S et al (2010) Prediction of silent ischemic lesions after carotid artery stenting using integrated backscatter ultrasound and magnetic resonance imaging. Atherosclerosis 208:161–166

    Article  CAS  PubMed  Google Scholar 

  11. Yamada K, Yoshimura S, Kawasaki M et al (2011) Embolic complications after carotid artery stenting or carotid endarterectomy are associated with tissue characteristics of carotid plaques evaluated by magnetic resonance imaging. Atherosclerosis 215:399–404

    Article  CAS  PubMed  Google Scholar 

  12. Yoshimura S, Yamada K, Kawasaki M et al (2011) High-Intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting. Stroke 42:3132–3137

    Article  PubMed  Google Scholar 

  13. Chung GH, Jeong JY, Kwak HS, Hwang SB (2016) Associations between cerebral embolism and carotid intraplaque hemorrhage during protected carotid artery stenting. AJNR Am J Neuroradiol 37:686–691

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Yoon W, Kim SK, Park MS, Chae HJ, Kang HK (2012) Safety of protected carotid artery stenting in patients with severe carotid artery stenosis and carotid intraplaque hemorrhage. AJNR Am J Neuroradiol 33:1027–1031

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Barnett HJM, Taylor DW, Haynes RB et al (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453

    Article  CAS  PubMed  Google Scholar 

  16. Lanzino G, Rabinstein AA, Brown RD (2009) Treatment of carotid artery stenosis: medical therapy, surgery, or stenting? Mayo Clin Proc 84:362–387

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chu B, Kampschulte A, Ferguson MS et al (2004) Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke 35:1079–1084

    Article  PubMed  Google Scholar 

  18. Kampschulte A, Ferguson MS, Kerwin WS et al (2004) Differentiation of intraplaque versus juxtaluminal hemorrhage/thrombus in advanced human carotid atherosclerotic lesions by in vivo magnetic resonance imaging. Circulation 110:3239–3244

    Article  CAS  PubMed  Google Scholar 

  19. Cai JM, Hastukami TS, Ferguson MS, Small R, Polissar NL, Yuan C (2002) Classification of human carotid atherosclerotic lesions with in vivo multicontrast magnetic resonance imaging. Circulation 106:1368–1373

    Article  PubMed  Google Scholar 

  20. Lokuge K, de Waard DD, Halliday A, Gray A, Bulbulia R, Mihaylova B (2018) Meta-analysis of the procedural risks of carotid endarterectomy and carotid artery stenting over time. Br J Surg 105:26–36

    Article  CAS  PubMed  Google Scholar 

  21. Schillinger M, Gschwendtner M, Reimers B et al (2008) Does carotid stent cell design matter? Stroke 39:905–909

    Article  PubMed  Google Scholar 

  22. Brinjikji W, Huston J, Rabinstein AA, Kim GM, Lerman A, Lanzino G (2016) Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg 124:27–42

    Article  CAS  PubMed  Google Scholar 

  23. Takaya N, Yuan C, Chu B et al (2005) Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation 111:2768–2775

    Article  PubMed  Google Scholar 

  24. Redgrave JN, Lovett JK, Gallagher PJ, Rothwell PM (2006) Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the Oxford plaque study. Circulation 113:2320–2328

    Article  CAS  PubMed  Google Scholar 

  25. Verhoeven B, Hellings WE, Moll FL et al (2005) Carotid atherosclerotic plaques in patients with transient ischemic attacks and stroke have unstable characteristics compared with plaques in asymptomatic and amaurosis fugax patients. J Vasc Surg 42:1075–1081

    Article  PubMed  Google Scholar 

  26. Yoshimura S, Yamada K, Kawasaki M et al (2013) Selection of carotid artery stenting or endarterectomy based on magnetic resonance plaque imaging reduced periprocedural adverse events. J Stroke Cerebrovasc Dis 22:1082–1087

    Article  PubMed  Google Scholar 

  27. Albuquerque LC, Narvaes LB, Maciel AA et al (2007) Intraplaque hemorrhage assessed by high-resolution magnetic resonance imaging and C-reactive protein in carotid atherosclerosis. J Vasc Surg 46:1130–1137

    Article  PubMed  Google Scholar 

  28. Bitar R, Moody AR, Leung G et al (2008) In vivo 3D high-spatial-resolution MR imaging of intraplaque hemorrhage. Radiology 249:259–267

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Aihua Ji and Peng Lv have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, 200032, China

    Aihua Ji, Peng Lv, Yuanyuan Dai, Xueqin Bai & Jiang Lin

  2. Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

    Xiao Tang

  3. Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China

    Caixia Fu

Authors
  1. Aihua Ji
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peng Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuanyuan Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xueqin Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiao Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caixia Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jiang Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jiang Lin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ji, A., Lv, P., Dai, Y. et al. Associations between carotid intraplaque hemorrhage and new ipsilateral ischemic lesions after carotid artery stenting: a quantitative study with conventional multi-contrast MRI. Int J Cardiovasc Imaging 35, 1047–1054 (2019). https://doi.org/10.1007/s10554-018-01521-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-018-01521-5

Keywords

Search

Navigation