High-Grade Internal Carotid Artery Stenosis and Chronic Brain Damage: A Volumetric Magnetic Resonance Imaging Study

Enzinger, Christian; Ropele, Stefan; Gattringer, Thomas; Langkammer, Christian; Schmidt, Reinhold; Fazekas, Franz

doi:10.1159/000319025

Cited by 27 publications

(21 citation statements)

References 55 publications

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“…The actual perfusion deficit can be underestimated from images taken of the posterior circulation [40]. Despite these limitations, our findings support the theory that carotid stenosis contributes to the pathogenesis of LA and that its elimination by CAS can reduce LA severity, suggesting the reversibility of ischemia-related LA [40]. It was shown that preoperative and postoperative LA scores depend on contralateral carotid stenosis and on whether the CoW is patent, and that LA responds to treatment.…”

Section: Discussionsupporting

confidence: 73%

“…The location of the arterial input function can influence to some extent perfusion-weighted imaging. The actual perfusion deficit can be underestimated from images taken of the posterior circulation [40]. Despite these limitations, our findings support the theory that carotid stenosis contributes to the pathogenesis of LA and that its elimination by CAS can reduce LA severity, suggesting the reversibility of ischemia-related LA [40].…”

Section: Discussionsupporting

confidence: 72%

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Immediate Regression of Leukoaraiosis after Carotid Artery Revascularization

et al. 2011

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Background: Leukoaraiosis (LA) affects cognition after stroke and reversal of LA may improve cognitive performance. We aimed to determine the impact of cerebral perfusion and circle of Willis (CoW) flow patterns on the extent of LA after carotid artery revascularization. Methods: LA was scored on fluid-attenuated inversion recovery magnetic resonance (MR) images at the levels of the centrum semiovale and frontal horns in both cerebral hemispheres of 62 contiguous patients (men/women = 38/24, mean age = 63.2 ± 8.4 years, range 44–82) before and after unilateral carotid artery revascularization. The pre- and poststenting differences in LA scores, CoW flow pattern on MR angiography, and MR perfusion parameters were analyzed. Results: The total LA score decreased from 9.87 ± 0.65 to 8.33 ± 0.72 after stenting (p = 0.03). The CoW was complete in 21 subjects and incomplete in 41 subjects. The incomplete CoW group had a higher preoperative LA load and higher cerebral interhemispheric asymmetry index, both of which decreased significantly postoperatively. Conclusions: CoW anomalies may contribute to LA in patients with carotid artery stenosis, and restoration of cerebral perfusion by carotid artery revascularization can reduce LA severity.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 72%

Immediate Regression of Leukoaraiosis after Carotid Artery Revascularization

et al. 2011

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“…We used visual WML scores rather than lesion volumes but, while volumes can give a more sensitive measure of WML, they may be distorted by accidental inclusion of infarcts that have similar signal to WML [16]. Although possibly less sensitive, visual WML scores are more specific as they do not suffer from this and related problems due to artifacts, and scores and volumes are closely related [17].…”

Section: Discussionmentioning

confidence: 99%

Lack of Association of White Matter Lesions with Ipsilateral Carotid Artery Stenosis

et al. 2012

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Background: White matter lesions (WML) are commonly seen on brain MRI and are generally considered a marker of tissue damage from cerebral small vessel disease. WML are associated with increasing age and vascular risk factors, but their precise cause is unknown. A role for carotid artery atherothromboemboli has been suggested. If this is the case, more WML would be expected ipsilateral to increasing degrees of carotid stenosis. Methods: We recruited patients with ischaemic stroke from two large, separate prospective stroke studies, assessed with brain MRI and carotid Doppler ultrasound. We scored hemispheric WML visually in periventricular and deep locations. We assessed the association between carotid stenosis asymmetry and WML asymmetry, and vice versa. Further, we assessed the association between carotid stenosis and ipsilateral WML, before and after adjusting for vascular risk factors, and tested associations between ipsilateral and contralateral stenoses and WML. Results: We recruited 247 (Study 1) and 253 (Study 2) patients. In Study 1 and Study 2, 36 (15%) and 29 (11%) patients had ≥50% carotid stenosis, and 27 (11%) and 15 (6%) had ≥70% stenosis, respectively. Carotid stenosis was asymmetric in 28 (11%) and 26 (10%) patients and WML were asymmetric in 22 (9%) and 11 (4%) patients in Study 1 and Study 2, respectively. We found no association between carotid stenosis and ipsilateral WML score, before or after adjusting for vascular risk factors or sidedness, but WML were strongly associated with increasing age (p < 0.001). Conclusion: In two large cohorts of ischaemic stroke patients, we found no association between carotid stenosis and ipsi- or contralateral WML. There is now substantial evidence that atherothromboemboli are unlikely to cause most WML or other forms of cerebral small vessel lesions. Future studies should focus on determining what causes the intrinsic small vessel pathological changes that appear to underlie most WML.

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“…Today, DSA is only rarely necessary—as opposed to the time when NASCET [3], ECST [4] and ACAS [5] were carried out. In addition to ultrasound, examinations such as CT and MR angiography allow collection of supplementary diagnostic insights, for example, perfusion studies, detection of vessel anomalies (aneurysms, angiomas), and plaque imaging, and can also be useful in cases where vessels are not well accessible via ultrasound or as an alternative investigation [26, 27]. …”

Section: Diagnostic Methodsmentioning

confidence: 99%

Asymptomatic and Symptomatic Carotid Stenosis: An Obsolete Classification?

Chatzikonstantinou

Wolf

Schaefer

et al. 2012

Stroke Research and Treatment

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Since many years, clinical decisions about the management of patients with carotid stenosis have been based on the distinction between “asymptomatic” and “symptomatic” presentations. This was also reflected by the design of previous studies on the surgical versus conservative treatment and of current studies on interventional treatment versus surgery. Both terms, however, only address different phases of activity of the one and the same condition and blur the significant message that carotid stenosis is a most important marker of systemic atherosclerosis, which is accompanied by a much higher risk of cardiovascular events rather than stroke. As a consequence, early diagnosis and followup during best medical treatment, life-style management, regular cardiovascular assessment, and good control of all vascular risk factors should be recommended in all patients with carotid stenosis—whether identified in the long-lasting “silent” or short-lasting “vulnerable” period lasting only a few weeks after cerebral ischemia. Patients in this short time window benefit from additional carotid intervention, under the condition of an individually favorable benefit-risk ratio (“individual vulnerability”).

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High-Grade Internal Carotid Artery Stenosis and Chronic Brain Damage: A Volumetric Magnetic Resonance Imaging Study

Cited by 27 publications

References 55 publications

Immediate Regression of Leukoaraiosis after Carotid Artery Revascularization

Immediate Regression of Leukoaraiosis after Carotid Artery Revascularization

Lack of Association of White Matter Lesions with Ipsilateral Carotid Artery Stenosis

Asymptomatic and Symptomatic Carotid Stenosis: An Obsolete Classification?

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