A Contemporary Evaluation of Carotid Artery Stenting Outcomes in Patients With Chronic Kidney Disease in the United States

Abstract

Objectives: Carotid plaque signal hyperintensity on T1-weighted magnetic resonance imaging (MRI) has been reported to represent intraplaque hemorrhage and to be associated with previous cerebral ischemic events. We applied this method as the preoperative assessment of aortic plaque to the patients undergoing arch replacement and compared the MRI findings with the resected pathologic samples.Methods: Ten patients who had aortic arch replacement for atherosclerotic aneurysm underwent plaque imaging using three-dimensional inversion recovery-based T1weighted MRI (magnetization-prepared rapid acquisition with gradient-echo [MPRAGE]) preoperatively. Aortic plaque with intensity on MPRAGE of >200% that of adjacent muscle was categorized as high signal intensity. Aortic samples were collected from 13 parts in the 10 patients that were >3 mm thick in preoperative computed tomography. Histopathologic evaluation was performed according to defect of fibrous cap or ulcer formation (0-3+) and presence of intraplaque erythrocytes (0-3+).Results: In the six parts corresponding to MPRAGE high signals, there was (1+) ulcer formation in 1, (2+) in 4, and (3+) in 1. As regard to presence of intraplaque erythrocyte, there were (1+) erythrocytes in 1, (2+) in 2, and (3+) in 3. In the remaining seven parts corresponding to MPRAGE no high signals, there was (1+) ulcer formation in five and (2+) in one, and there were (1+) intraplaque erythrocytes in six and (2+) in one. Dividing the severity of these findings into two categories (mild ¼ grade 0 and 1, and severe ¼ grade 2 and 3), there was more severe ulcer formation (P ¼ .016) and more accumulation of intraplaque erythrocytes (P ¼ .016) in the samples corresponding to MPRAGE high signals.Conclusions: MPRAGE high signal in aortic wall was associated with deficit of fibrous cap and ulcer formation resulting in accumulation of intraplaque erythrocytes. These findings would be useful to avoid embolic events in aortic surgery, especially in endovascular repair.