Carotid intraplaque hemorrhage detected by magnetic resonance imaging predicts embolization during carotid endarterectomy

Abstract

Intraplaque hemorrhage as detected by carotid MRI predicts particulate embolization during the dissection phase of CEA. This imaging technique can be used to identify patients with increased intraoperative thromboembolic risk, and this could influence preventive strategies.

Optimal MR Plaque Imaging for Cervical Carotid Artery Stenosis in Predicting the Development of Microembolic Signals during Exposure of Carotid Arteries in Endarterectomy: Comparison of 4 T1-Weighted Imaging Techniques

“…The high association of hemorrhage or fibrous tissue corresponded with previous findings. 9,12 In contrast, no reports have described the reduced association for lipid/necrosis. Signal intensity for each component in the carotid plaque is, in descending order, hemorrhage, lipid/necrosis, and fibrous tissue in any MR plaque imaging.…”

“…[5][6][7][9][10][11] Several investigators have compared MES during the exposure procedure for the carotid arteries in CEA with histopathologic findings of excised carotid plaque and have demonstrated that development of the MES was strongly associated with vulnerable carotid plaques consisting primarily of intraplaque hemorrhage and/or intraluminal thrombus. 12,13 Intraplaque hemorrhage might cause formation of intraluminal thrombus likely due to chemical mediators, increased stenosis, or changes in eddy currents, though the associations among these remain unclear. Other research has shown that more cerebrovascular adverse events related to CEA occurred in patients with atheromatous plaques compared with patients with fibrous plaques.…”

“…Intraplaque characteristics are generally assessed by using MR imaging based on T1-weighted sequences, 14 and the detection of intraplaque hemorrhage on preoperative MR imaging is associated with the development of MES during the procedure for exposure of the carotid arteries. 12 However, there has been inconsistency among published findings on vulnerable plaques. 15 This could be due to interinstitutional differences in the methodology for such imaging techniques as cardiac-gated black-blood fast spin-echo (BB-FSE), [16][17][18][19] magnetization-prepared rapid acquisition of gradient echo, 12,[20][21][22] source image of 3D time-of-flight MR angiography (SI-MRA), 23 and noncardiac-gated spin-echo (SE).…”

“…12 However, there has been inconsistency among published findings on vulnerable plaques. 15 This could be due to interinstitutional differences in the methodology for such imaging techniques as cardiac-gated black-blood fast spin-echo (BB-FSE), [16][17][18][19] magnetization-prepared rapid acquisition of gradient echo, 12,[20][21][22] source image of 3D time-of-flight MR angiography (SI-MRA), 23 and noncardiac-gated spin-echo (SE). 15,24,25 Although the cardiac-gated BB-FSE method is most commonly used for T1-weighted MR plaque imaging, 17,18 the TR is dependent on a single R-R interval from electrocardiography, which occasionally results in an overly long TR to diminish proton density-weighted contrast and to enhance T1-weighted contrast.…”

Safety of Protected Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis and Carotid Intraplaque Hemorrhage

“…22 Altaf et al 17 found that carotid IPH, observed on MR imaging scans, is significantly associated with an increased risk of microembolization, detected on a transcranial Doppler imaging scan during the dissection phase of carotid endarterectomy. They suggested that the presence of IPH is a strong indicator of a carotid plaque that is likely to cause embolization during endarterectomy, and therefore the patient has a higher perioperative risk.…”