Brain diffusion changes in unilateral carotid artery stenosis with non-shunt endarterectomy: Correlation with white matter lesions

Şahin, Neslın; Solak, Aynur; Genç, Berhan; Akpınar, Mehmet Beşir; Kulu, Ugur; Cengiz, Hakan

doi:10.1016/j.clineuro.2015.03.002

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…In our study, there was no association between new MES in DWI-MRI and cognitive and functional status. The incidence of new MES observed in DWI-MRI 24–48 h after PTA was 7/13 (54%), while after CEA it was 1/5 (20%), which is consistent with the available literature [ 13 – 16 , 39 , 40 ].…”

Section: Discussionsupporting

confidence: 90%

Magnetic resonance imaging and clinical outcome in patients with symptomatic carotid artery stenosis after carotid artery revascularization

Badacz¹,

Kabłak‐Ziembicka²,

Urbańczyk‐Zawadzka³

et al. 2017

pwki

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IntroductionAbout 30% of patients with carotid artery stenosis (CAS) develop dementia after a cerebral ischemic event (CIE), and 20–50% suffer from CIE recurrence during 6 months. Carotid artery revascularization (CAR) may prevent CIE recurrence, at the cost of new microembolic lesions (MES). The impact of CAR on cognitive function is debatable.AimTo assess functional and cognitive outcome, cerebral flow on transcranial Doppler (TCD) and brain magnetic resonance imaging (MRI) in patients with symptomatic CAS referred for CAR.Material and methodsTwenty-two patients (aged 69.0 ±7.2 y.o., 15 male) with recent CIE (21.9 ±20.9 days to CAR) related to CAS of mean 89.8 ±3.9% lumen reduction were prospectively evaluated with TCD, diffusion and perfusion MRI, Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS) 24 h before, at 24–48 h and 1 month following CAR.ResultsNew MES were found in 11 (50%) subjects following CAR. CAR resulted in a significant increase of cerebral flow velocity in the middle and anterior cerebral arteries (p < 0.002 and p = 0.003; respectively) and cerebral perfusion measured by time to peak (TTP) and mean transit time (MTT) (p = 0.0009 and p = 0.0002; respectively). Neurologic tests showed improvement in NIHSS (2.4 ±1.6 to 1.5 ±1.2, p = 0.003), mRS (from 1.3 ±0.9 to 0.7 ±0.9, p = 0.005), and MMSE (26.7 ±2.2 to 27.6 ±2.3, p = 0.019) at 1 month, while similar MoCA scores were observed before and 1 month after CAR (23.4 ±3.3 vs. 24.1 ±3.7, p = 0.136).ConclusionsImprovement of cerebral flow and perfusion and functional outcome, as well as at least no cognitive decline, is observed after CAR for symptomatic CAS.

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Section: Discussionsupporting

confidence: 90%

Magnetic resonance imaging and clinical outcome in patients with symptomatic carotid artery stenosis after carotid artery revascularization

Badacz¹,

Kabłak‐Ziembicka²,

Urbańczyk‐Zawadzka³

et al. 2017

pwki

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“…Seventy-nine studies were excluded for the following reasons: MRI to detect cerebral ischaemia did not include DWI sequences, or DWI was not done in all patients (n = 15); 22–36 no DWI was performed before treatment (n = 11); 37–47 post-procedural DWI was performed more than seven days after treatment (n = 3); 48–50 the number of DWI+ patients or procedures could not be extracted (n = 6); 51–56 or information on procedural stroke was lacking or patients with procedural stroke were excluded from the analysis (n = 6). 49,57–68 One study was excluded because the analysis was restricted to patients with available six months’ follow-up who constituted less than half of the study population (n = 1). 69 One study was excluded since only pre-selected groups of patients showing micro-embolic signals in transcranial Doppler during CEA were included in the final analysis.…”

Section: Resultsmentioning

confidence: 99%

Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis

Traenka

Engelter

Brown³

et al. 2019

European Stroke Journal

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Aim: To investigate whether lesions on diffusion-weighted imaging (DWIþ) after carotid artery stenting (CAS) or endarterectomy (CEA) might provide a surrogate outcome measure for procedural stroke. Materials and Methods: Systematic MedLine V R database search with selection of all studies published up to the end of 2016 in which DWI scans were obtained before and within seven days after CAS or CEA. The correlation between the underlying log odds of stroke and of DWIþ across all treatment groups (i.e. CAS or CEA groups) from included studies was estimated using a bivariate random effects logistic regression model. Relative risks of DWIþ and stroke in studies comparing CAS vs. CEA were estimated using fixed-effect Mantel-Haenszel models. Results: We included data of 4871 CAS and 2099 CEA procedures (85 studies). Across all treatment groups (CAS and CEA), the log odds for DWIþ was significantly associated with the log odds for clinically manifest stroke (correlation coefficient 0.61 (95% CI 0.27 to 0.87), p ¼ 0.0012). Across all carotid artery stenting groups, the correlation coefficient was 0.19 (p ¼ 0.074). There were too few CEA groups to reliably estimate a correlation coefficient in this subset alone. In 19 studies comparing CAS vs. CEA, the relative risks (95% confidence intervals) of DWIþ and stroke were 3.83 (3.17-4.63, p < 0.00001) and 2.38 (1.44-3.94, p ¼ 0.0007), respectively. Discussion: This systematic meta-analysis demonstrates a correlation between the occurrence of silent brain infarcts on diffusion-weighted imaging and the risk of clinically manifest stroke in carotid revascularisation procedures. Conclusion: Our findings strengthen the evidence base for the use of DWI as a surrogate outcome measure for procedural stroke in carotid revascularisation procedures. Further randomised studies comparing treatment effects on DWI lesions and clinical stroke are needed to fully establish surrogacy.

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“…Previous studies comparing the burden of white matter lesions between ipsilateral and contralateral to carotid atherosclerosis stenosis sites and reported conflicting findings. Some studies (Enzinger et al, 2010;Sahin et al, 2015) found a significantly higher load of white matter lesions ipsilateral to carotid atherosclerotic stenosis. However, other studies demonstrated that there was no association between increasing lumen stenosis and ipsilateral WMH volume in patients suffering from either acute infarctions or transient ischemic attack (TIA) by using subjective and/or volumetric analysis of WMHs (Altaf et al, 2008;Potter et al, 2012;Schulz et al, 2013;Wardlaw et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

The Asymmetry of White Matter Hyperintensity Burden Between Hemispheres Is Associated With Intracranial Atherosclerotic Plaque Enhancement Grade

Zhou

Qing

et al. 2020

Front. Aging Neurosci.

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The contribution of intracranial atherosclerotic stenosis (ICAS) to the development of white matter hyperintensities (WMHs) has not been fully elucidated. We aimed to retrospectively assess the relationship between WMH burden and unilateral ICAS by combined examination of lumen stenosis, plaque enhancement, and cerebral perfusion. Materials and methods: A cross-sectional study of 41 patients with symptomatic unilateral ICAS (mean age 57 ± 10 years; 26 males) was conducted. Detailed clinical data, including vascular risk factors, were obtained. WMH volume was derived from 3D-fluid-attenuated inversion recovery (3D-FLAIR) and was assessed by using a validated semi-automated protocol. Lumen stenosis, plaque enhancement, and cerebral perfusion (assessed on time-to-peak parameter using the Alberta Stroke Program Early CT score (TTP-ASPECTS) scale) were evaluated. The WMH volumes of peri-ventricular (PWMH) and deep (DWMH) white matter were calculated separately and compared between hemispheres. Associations between WMH volume (inter-hemispheric volume difference, ipsilateral and contralateral to the ICAS site separately), unilateral ICAS imaging metrics, and vascular risk factors were assessed by using linear regression. Results: The DWMH volume ipsilateral to the ICAS site (ipsilateral DWMH volume) was significantly greater than that of the contralateral site (P < 0.001), while the PWMH volume difference between hemispheres did not reach statistical significance. The interhemispheric DWMH volume difference was significantly associated with a higher plaque enhancement grade (β = 0.436, P = 0.005) and inversely associated with cerebral hypoperfusion (lower TTP-ASPECTS) (β = −0.613, P < 0.001). In the between-subject multivariable regression analysis, while older age (β = 0.323, P = 0.025), hypoperfusion (β = −0.394, P = 0.007), and hypertension (β = 0.378, P = 0.011) were independently associated with ipsilateral DWMH volume, plaque enhancement did not show an

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Brain diffusion changes in unilateral carotid artery stenosis with non-shunt endarterectomy: Correlation with white matter lesions

Cited by 5 publications

References 23 publications

Magnetic resonance imaging and clinical outcome in patients with symptomatic carotid artery stenosis after carotid artery revascularization

Magnetic resonance imaging and clinical outcome in patients with symptomatic carotid artery stenosis after carotid artery revascularization

Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis

The Asymmetry of White Matter Hyperintensity Burden Between Hemispheres Is Associated With Intracranial Atherosclerotic Plaque Enhancement Grade

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