Recent Intraplaque Hemorrhage Is Associated with a Higher Risk of Ipsilateral Cerebral Embolism During Carotid Artery Stenting.

Abstract

OBJECTIVE:

The purpose of this study was to identify which stage of intraplaque hemorrhage (IPH) is an independent risk factor for ipsilateral new ischemic lesions (NILs) after carotid artery stenting (CAS).

METHODS:

In 268 patients treated with CAS, the association between postoperative ipsilateral NILs on diffusion-weighted imaging (DWI) and patient demographics, intraoperative factors, and plaque characteristics on multicontrast atherosclerosis characterization sequence was retrospectively analyzed.

RESULTS:

A total of 268 patients were enrolled in the study. Ipsilateral NILs on DWI were detected in 32.8% of patients. Univariate analysis showed that the stage of IPH (along with lipid-rich necrotic core [LRNC]) (P < 0.001) in the carotid plaque, predilation (P = 0.012), stent type (P = 0.002), and aortic arch ulcer (P = 0.009) were associated with postoperative ipsilateral NILs, whereas other patient-related factors (P >0.05), type of embolic protection device (P = 0.072), postdilation (P = 0.388), calcification (P = 0.140), and LRNC (without IPH) (P = 0.086) were not. Multivariate logistic regression analysis showed that the acute and recent IPH (along with LRNC) (odds ratio [OR], 3.78, P = 0.011 and OR, 16.73, P < 0.001, respectively), aortic arch ulcer (OR, 2.46; P = 0.006), predilation (OR, 4.78; P = 0.015), and open cell stent (OR, 4.19; P < 0.001) were significantly associated with postoperative ipsilateral NILs on DWI.

CONCLUSIONS:

Screening for recent IPH in carotid plaques using multicontrast atherosclerosis characterization sequence may identify plaques at a higher risk for cerebral embolism during CAS.

• Authors: Gefei Zhao, Xiao Tang, Hanfei Tang, Jiang Lin, Wei Sun, Zhaoyang Fan, Caixia Fu, Daqiao Guo
• Journal: World neurosurgery (World Neurosurg) Vol. 137 Pg. e298-e307 (05 2020) ISSN: 1878-8769 [Electronic] United States
• PMID: 32014542 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Aged
• Carotid Stenosis (diagnostic imaging, pathology, surgery)
• Diffusion Magnetic Resonance Imaging (methods)
• Female
• Hemorrhage (diagnostic imaging)
• Humans
• Intracranial Embolism (etiology)
• Male
• Plaque, Atherosclerotic (diagnostic imaging, pathology, surgery)
• Retrospective Studies
• Risk Factors
• Stents