Carotid intraplaque hemorrhage detected by magnetic resonance imaging predicts embolization during carotid endarterectomy
Received 28 November 2006; accepted 28 February 2007. published online 04 June 2007.
Background
Microembolization detected during the dissection phase of carotid endarterectomy (CEA) is associated with plaque instability and might be associated with perioperative morbidity. Intraplaque hemorrhage is found in unstable plaques and is detectable using magnetic resonance imaging (MRI). We aimed to ascertain whether intraplaque hemorrhage as seen on carotid MRI predicts particulate embolization in the dissection phase of CEA.
Methods
Patients with high-grade symptomatic carotid stenosis undergoing CEA were prospectively enrolled. All underwent preoperative MRI assessment of the carotid arteries for intraplaque hemorrhage and transcranial Doppler scanning during the dissection phase of the CEA to assess the presence of microembolic signals. Associations between intraplaque hemorrhage and intraoperative microembolic signals were studied.
Results
Analysis was undertaken on 60 participants; of these, 36 (60%) showed ipsilateral carotid MRI intraplaque hemorrhage, and 24 (40%) did not. Microembolic signals were detected during the dissection phase in 23 (38.3%) participants, and 19 had MRI-detected intraplaque hemorrhage. The association between carotid intraplaque hemorrhage and the presence of dissection phase microembolic signals was significant (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.6 to 19.7, P = .007), even after controlling for age, sex, individual surgeon, degree of stenosis, and delay from symptom to CEA (adjusted OR, 5.8; 95% CI, 1.1 to 30.4, P = .037).
Conclusion
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.
aDepartment of Vascular and Endovascular Surgery, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
bDepartment of Academic Radiology, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
cDivision of Rehabilitation and Ageing, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
dDepartment of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Reprint requests: Nishath Altaf, Department of Vascular and Endovascular Surgery, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK.
This study received funding from the Stroke Association, UK; Mason Medical Research Foundation, Special Trustees of Nottingham University Hospitals and Queen’s Medical Centre Vascular Surgical Research.
ABSTRACT