Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy

Barth, Alain; Remonda, Luca; Lövblad, Karl‐Olof; Schroth, Gerhard; Seiler, Rolf W.

doi:10.1161/01.str.31.8.1824

Cited by 73 publications

(44 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite the small sample size, this result is acceptable compared with previous reports evaluating postoperative ischemic lesion with diffusionweighted MR imaging. 1,5,7,12,15,18) We assumed that these ischemic lesions were emboli since the total times for shunt insertion and plaque removal were not longer compared to other cases in this series without lesions, although we could not investigate the definite mean time of shunt manipulation because of the retrospective nature of this study.…”

Section: Discussionmentioning

confidence: 98%

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Inoue

Tsutsumi

Maeda³

et al. 2006

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Temporary intraluminal shunt was used during 72 consecutive carotid endarterectomies (CEAs) in 61 patients (bilateral CEA in 11 patients) during October 2001 and September 2005. The medical records of these patients were retrospectively reviewed. All procedures were performed with routine shunt insertion without monitoring such as electroencephalography. Pre-and postoperative diffusion-weighted magnetic resonance (MR) imaging was used to detect ischemic complications. Postoperative angiography was performed in 70 cases to detect abnormalities such as major stenosis or dissection of the distal end. Symptomatic ischemic complication occurred in one patient at 1 month. Postoperative diffusion-weighted MR imaging detected new hyperintense lesions in three patients including the symptomatic patient. Postoperative angiography confirmed that the distal end was satisfactory in all cases. The incidence of ischemic lesions of embolic origin after CEA with routine shunt usage is acceptably low if the procedure of shunt device insertion and removal is meticulously conducted.

show abstract

Section: Discussionmentioning

confidence: 98%

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Inoue

Tsutsumi

Maeda³

et al. 2006

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

show abstract

“…22 This could explain why no correlation was found between the total number of microembolic signals measured with transcranial Doppler during the procedure and DWI-detected lesions. 18,23 Therefore, DWI can be considered one of the most robust methods to monitor the effects of endovascular therapies.…”

Section: Discussionmentioning

confidence: 99%

Silent Cerebral Ischemia Detected With Diffusion-Weighted Imaging in Patients Treated With Protected and Unprotected Carotid Artery Stenting

Cosottini

Michelassi

Puglioli

et al. 2005

Stroke

View full text Add to dashboard Cite

Background and Purpose-Percutaneous transluminal angioplasty with stent (CAS) is an alternative method to endarterectomy in the revascularization of carotid artery stenosis. Protected CAS is currently used to prevent distal embolization. Diffusion-weighted MRI (DWI) is the most sensitive tool to evaluate silent cerebral ischemia. The purpose of this research was to assess the incidence of cerebral embolic lesions during CAS and to evaluate whether cerebral protection devices can reduce the number of silent cerebral ischemia with respect to unprotected CAS. Methods-Fifty-two patients with high-grade internal stenosis underwent CAS; 30 patients (group a) were treated with a cerebral protection device, and 22 (group b) were treated without it. All of the patients were evaluated preoperatively and postoperatively with fluid-attenuated inversion recovery and DWI sequences to depict the number of new embolic silent cerebral lesions. Results-Embolic

show abstract

“…12,13 The preoperative workup and technical details of CEA have been described previously. 14,15 All operations were performed by the same surgeon (A.B.) or under his direct supervision.…”

Section: Methodsmentioning

confidence: 99%

Patient Selection for Carotid Endarterectomy

Barth

2003

Stroke

Self Cite

View full text Add to dashboard Cite

Background and Purpose-Risk-factor modeling has been proposed to identify patients with carotid stenosis who will most benefit from surgery. Validation by independent institutions performing carotid endarterectomy is necessary to determine the applicability of such models to the individual patient. Methods-A series of patients with a recently symptomatic high-grade carotid stenosis were selected for surgery according to current guidelines and were consecutively operated on in a single institution. In addition, a prognostic model was applied to the patients to analyze the concordance of both selection methods. Results-The study included 134 patients operated on between 1999 and 2001. The risk model predicted that 49% of the patients should have been excluded from surgery because the operation was found to be possibly harmful in 1 patient (1%) and not significantly beneficial in 65 patients (48%). This resulted from the predominant negative weight of the surgical risk factors in the model. However, this predominance was negated in our series by the fact that only 1 major complication (0.75%) occurred during follow-up. Key Words: carotid endarterectomy Ⅲ carotid stenosis Ⅲ patient selection Ⅲ risk assessment T he best indication for carotid endarterectomy (CEA) is a recently symptomatic high-grade carotid stenosis. 1-4 Provided that no major complication occurs during the operation, most patients find themselves efficiently protected against stroke in the following years. 5,6 The operative technique is well standardized, and the risk of restenosis is very low in experienced centers. 5 However, from an epidemiological point of view, there is a need to better select the surgical candidates because only 20% to 25% of patients medically treated have a stroke or die of stroke during the following 3 years. This means that preventive surgery remains without benefit for at least 4 of 5 operated patients. This proportion could even be increased by the ability of new statins to combat hypercholesterolemia and stabilize atherosclerotic plaques more efficiently than at the time of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST). 7 According to current guidelines, 8,9 CEA is recommended for patients with a symptomatic high-grade stenosis when the estimated rate of perioperative complications does not exceed 6%. Because the risk of stroke is highest during the first 2 to 3 years, life expectancy should be at least 2 years when the operation is proposed. In an effort to identify the best surgical candidates, ie, patients with high risk of stroke on medical treatment alone and with low risk of operative complications and death, Rothwell et al 10 developed a prognostic model based on a balance of medical and surgical risk factors. The statistical data were gathered from 2060 ECST patients with 0% to 69% carotid stenosis. 1,2 The model was tested and validated in 990 ECST patients with 70% to 99% carotid stenosis assigned to endarterectomy (nϭ596) or medical treatment on...

show abstract

Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy

Cited by 73 publications

References 44 publications

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Incidence of Ischemic Lesions by Diffusion-Weighted Imaging After Carotid Endarterectomy With Routine Shunt Usage

Silent Cerebral Ischemia Detected With Diffusion-Weighted Imaging in Patients Treated With Protected and Unprotected Carotid Artery Stenting

Patient Selection for Carotid Endarterectomy

Contact Info

Product

Resources

About