Evaluation of factors increasing the risk of silent brain infarction using multidetector computed tomography in patients undergoing carotid artery stenting

Objectives: We tested the hypothesis that computed tomography (CT) perfusion markers of cerebral microcirculation would improve 36 months after internal carotid artery stenting for symptomatic carotid stenosis while results obtained 6–8 weeks after the stenting procedure would yield a predictive value. Methods: We recruited consecutive eligible patients with >70% symptomatic carotid stenosis with a complete circle of Willis and normal vertebral arteries to the observational cohort study. We detected changes in the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and permeability surface area-product (PS) before and after carotid stenting. We have also compared the absolute differences in the ipsilateral and contralateral CT perfusion markers before and after stenting. The search for regression models of “36 months after stenting” results was based on a stepwise analysis with bidirectional elimination method. Results: A total of 34 patients completed the 36 months follow-up (15 females, mean age of 69.68±S.D. 7.61 years). At 36 months after stenting, the absolute values for CT perfusion markers had improved: CBF (ipsilateral: +7.76%, contralateral: +0.95%); CBV (ipsilateral: +5.13%, contralateral: +3.00%); MTT (ipsilateral: –12.90%; contralateral: –5.63%); TTP (ipsilateral: –2.10%, contralateral: –4.73%) and PS (ipsilateral: –35.21%, contralateral: –35.45%). MTT assessed 6–8 weeks after stenting predicted the MTT value 36 months after stenting (ipsilateral: R2=0.867, contralateral R2=0.688). Conclusions: We have demonstrated improvements in CT perfusion markers of cerebral microcirculation health that persist for at least 3 years after carotid artery stenting in symptomatic patients. MTT assessed 6–8 weeks after stenting yields a predictive value.

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Relationship between carotid plaque characteristics and new ischemic lesions after stenting detected by computed tomography angiography

Acta Radiologica ◽

10.1177/0284185119852732 ◽

2019 ◽

Vol 61 (1) ◽

pp. 47-55

Author(s):

Hongying Qu ◽

Xiaokun Zhang ◽

Miao Zhang ◽

Yongan Gao ◽

Jie Lu

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Plaque ◽

Diffusion Weighted Imaging ◽

Irregular Surface ◽

Irregular Surfaces ◽

Diffusion Weighted ◽

Peripheral Position

Background Although carotid artery stenting achieves definite benefits, it carries a higher rate of embolization compared with carotid endarterectomy. The incidence of embolization may be related to plaque stability. Purpose To assess for any relationship between plaque characteristics and cerebral emboli following carotid artery stenting. Material and Methods Sixty-three patients with severe carotid stenosis underwent carotid artery stenting. They were divided into two groups according to whether new ischemic lesions were detected on diffusion-weighted imaging after carotid artery stenting. We evaluated the types and locations of calcification in plaques and extent of calcification. We then assessed for a correlation between each of these factors and occurrence of new lesions on diffusion-weighted imaging after carotid artery stenting. Results The locations of calcification, percentage of plaque enhancement, and the number of plaques with irregular surface or ulceration were significantly different between the two groups. A peripheral position of calcification (close to the adventitia), enhancing plaques, and plaques with irregular surfaces or ulceration were statistically significant predictors of intracerebral embolization after carotid artery stenting. No significant differences in type of plaque or degree of calcification were found between two groups. Conclusion Peripheral calcification, enhancing plaques, and plaques with irregular surfaces were risk factors for intracerebral embolization after carotid artery stenting. These plaque characteristics should be considered when choosing the optimal treatment for patients.

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Single-photon emission computed tomography and transcranial color-coded real-time sonography studies can predict hyperperfusion syndrome after carotid artery stenting

Cerebral Blood Flow and Metabolism (Japanese journal of cerebral blood flow and metabolism) ◽

10.16977/cbfm.26.2_173 ◽

2015 ◽

Vol 26 (2) ◽

pp. 173-176

Author(s):

Tomonori Iwata

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Real Time ◽

Carotid Artery Stenting ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Single Photon Emission ◽

Single Photon Emission Computed ◽

Photon Emission Computed Tomography

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Effects of Carotid Calcification on Restenosis After Carotid Artery Stenting: A Follow-Up Study With Computed Tomography Angiography

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.08.142 ◽

2018 ◽

Vol 68 (4) ◽

pp. 1272

Author(s):

C.H. Kim ◽

J.S. Kang ◽

W.S. Ryu ◽

C.H. Sohn ◽

B.W. Yoon

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Computed Tomography Angiography ◽

Carotid Artery Stenting ◽

Follow Up Study ◽

Carotid Calcification

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Silent Brain Infarction in Patients With Asymptomatic Carotid Artery Atherosclerotic Disease

Journal of Vascular Surgery ◽

10.1016/j.jvs.2016.06.054 ◽

2016 ◽

Vol 64 (2) ◽

pp. 534-535 ◽

Cited By ~ 1

Author(s):

H. Baradaran ◽

G. Gialdini ◽

E. Mtui

Keyword(s):

Carotid Artery ◽

Brain Infarction ◽

Atherosclerotic Disease ◽

Asymptomatic Carotid ◽

Silent Brain Infarction

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Carotid artery stenting before surgery for carotid artery occlusion associated with acute type A aortic dissection: Two case reports

Interventional Neuroradiology ◽

10.1177/1591019920925690 ◽

2020 ◽

Vol 26 (6) ◽

pp. 814-820

Author(s):

Yusuke Funakoshi ◽

Hirotoshi Imamura ◽

So Tokunaga ◽

Yasutaka Murakami ◽

Shoichi Tani ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Carotid Artery ◽

Common Carotid Artery ◽

Carotid Artery Stenting ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Acute Type ◽

Common Carotid Artery Occlusion ◽

Hemiarch Replacement

Background We experienced two cases of ischemic stroke resulting from carotid artery occlusion associated with acute type A aortic dissection (ATAAD), in which carotid artery stenting before the surgery for ATAAD resulted in good clinical outcomes. Case 1 description: A 63-year-old woman was hospitalized for conscious disturbance, right hemiparesis, and total aphasia. Computed tomography of the head showed no abnormal findings. Computed tomography angiography showed ATAAD and bilateral common carotid artery occlusion. Surgery was not indicated for ATAAD because of a poor prognosis of ischemic stroke. However, carotid artery stenting of the left common carotid artery occlusion was successfully performed, and her neurological findings improved. The patient underwent hemiarch replacement for ATAAD on the day after carotid artery stenting. Her final modified Rankin Scale was 1. Case 2 Description: A 57-year-old woman was hospitalized for mild left hemiparesis. Magnetic resonance imaging showed right watershed infarction and right common carotid artery occlusion. Computed tomography angiography showed ATAAD. After hospitalization, conscious disturbance appeared and left hemiparesis worsened. Ischemic stroke indicated a poor prognosis for revascularization by surgery for ATAAD. Thus, carotid artery stenting of the right common carotid artery occlusion was performed. The patient’s neurological findings improved and she underwent hemiarch replacement for ATAAD at 19 days after carotid artery stenting. Her final modified Rankin Scale was 1. Conclusions In the present cases, although ischemic stroke was serious and precluded surgical indication for ATAAD, carotid artery stenting before surgery for ATAAD resulted in good clinical outcomes. Performing carotid artery stenting before surgery for ATAAD is challenging but achievable, and is a valid treatment option depending on the individual cases.

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Intraprocedural Detection of Cerebral Hyperperfusion by Flat Detector Computed Tomography in the Evaluation of Cerebral Blood Volume during Carotid Artery Stenting

Interventional Neuroradiology ◽

10.15274/inr-2014-10044 ◽

2014 ◽

Vol 20 (4) ◽

pp. 502-509 ◽

Cited By ~ 5

Author(s):

Yukinori Terada ◽

Taketo Hatano ◽

Yasunori Nagai ◽

Makoto Hayase ◽

Masashi Oda ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Blood Volume ◽

Carotid Artery Stenting ◽

Cerebral Blood Volume ◽

Present Report ◽

Neurological Deficits ◽

Flat Detector ◽

Cerebral Hyperperfusion ◽

Angiography Suite

Cerebral blood volume (CBV) can be measured using a C-arm flat detector angiographic system. The present report describes a case in which cerebral hyperperfusion was detected with the Neuro parenchymal blood volume (PBV) system (syngo Neuro PBV IR, Siemens Medical Solutions, Erlangen, Germany) during carotid artery stenting (CAS). An 89-year-old man was referred to our hospital for cerebral brain infarction and severe stenosis of the left carotid artery. CAS was performed, and Neuro PBV was used to measure CBV both during and after the procedure. Postoperative Neuro PBV revealed dramatically increased CBV, and a hyperperfusion state was suspected. The next day, subarachnoid hemorrhage along the sulcus of the left hemisphere was revealed on computed tomography. Strict management of blood pressure was instituted just after the detection of hyperperfusion, and the patient was ultimately discharged from the hospital without any new neurological deficits. Neuro PBV has the advantage that it can be performed in the angiography suite and does not require patient transfer to an alternate setting. Therefore, intracranial hemodynamic changes can be detected during the procedure. We conclude that the Neuro PBV system is useful for monitoring intracranial hemodynamics during endovascular procedures.

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Unknown internal carotid artery atherosclerotic stenoses detected with biphasic multidetector computed tomography for head and neck cancer

European Radiology ◽

10.1007/s00330-005-0023-2 ◽

2005 ◽

Vol 16 (4) ◽

pp. 866-871 ◽

Cited By ~ 4

Author(s):

Nicola Flor ◽

Francesco Sardanelli ◽

Simone Soldi ◽

Giuseppe Franceschelli ◽

Caterina Missiroli ◽

...

Keyword(s):

Computed Tomography ◽

Head And Neck Cancer ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Head And Neck ◽

Multidetector Computed Tomography ◽

Neck Cancer ◽

Internal Carotid

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Computed Tomography Texture Analysis of Carotid Plaque as Predictor of Unfavorable Outcome after Carotid Artery Stenting: A Preliminary Study

Diagnostics ◽

10.3390/diagnostics11122214 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2214

Author(s):

Davide Colombi ◽

Flavio Cesare Bodini ◽

Beatrice Rossi ◽

Margherita Bossalini ◽

Camilla Risoli ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Plaque ◽

Independent Predictor ◽

Multiple Logistic Regression Analysis ◽

Unfavorable Outcome ◽

Textural Features ◽

Roc Curve Analysis ◽

Density Histogram

Novel biomarkers are advocated to manage carotid plaques. Therefore, we aimed to test the association between textural features of carotid plaque at computed tomography angiography (CTA) and unfavorable outcome after carotid artery stenting (CAS). Between January 2010 and January 2021, were selected 172 patients (median age, 77 years; 112/172, 65% men) who underwent CAS with CTA of the supra-aortic vessels performed within prior 6 months. Standard descriptors of the density histogram were derived by open-source software automated analysis obtained by CTA plaque segmentation. Multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the area under the ROC (AUC) were used to identify potential prognostic variables and to assess the model performance for predicting unfavorable outcome (periprocedural death or myocardial infarction and any ipsilateral acute neurological event). Unfavorable outcome occurred in 17/172 (10%) patients (median age, 79 years; 12/17, 70% men). Kurtosis was an independent predictor of unfavorable outcome (odds ratio, 0.79; confidence interval, 0.65–0.97; p = 0.029). The predictive model for unfavorable outcome including CTA textural features outperformed the model without textural features (AUC 0.789 vs 0.695, p = 0.004). In patients with stenotic carotid plaque, kurtosis derived by CTA density histogram analysis is an independent predictor of unfavorable outcome after CAS.

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