Magnetic resonance plaque imaging to predict the occurrence of the slow-flow phenomenon in carotid artery stenting procedures

Sakamoto, Masahiko; Taoka, Toshiaki; Nakagawa, Hiroyuki; Takayama, Katsutoshi; Wada, Takeshi; Myouchin, Kaoru; Akashi, Toshiaki; Miyasaka, Toshiteru; Fukusumi, Akio; Iwasaki, Shigeo; Kichikawa, Kimihiko

doi:10.1007/s00234-009-0623-7

Cited by 33 publications

(30 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…21 In their study, slow-flow phenomena occurred in 10 of 31 CAS procedures, and 7 of 10 slow-flow phenomena were observed in patients with carotid IPH, revealed by multicontrast MR plaque imaging. We observed no slow-flow phenomena in this study.…”

mentioning

confidence: 95%

Safety of Protected Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis and Carotid Intraplaque Hemorrhage

Yoon

Kim²,

Park³

et al. 2012

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

mentioning

confidence: 95%

Safety of Protected Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis and Carotid Intraplaque Hemorrhage

Yoon

Kim²,

Park³

et al. 2012

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…3 Various evaluation methods for plaque vulnerability have been reported; 11,23,28 evaluation using signal intensity on carotid artery MRI is also used in clinical practice 14,25 and is useful for identification of high-risk lesions. 13,19 Recent technological developments in MRI equipment and imaging sequencing make it possible to assess the carotid plaque components.…”

Section: Discussionmentioning

confidence: 99%

Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity

Kurosaki

Yoshida

Fukumitsu

et al. 2016

JNS

View full text Add to dashboard Cite

C arotid artery atherosclerosis is one of the important causes of ischemic stroke. The efficacy of carotid endarterectomy (CEA) for severe symptomatic stenosis of the carotid artery has been demonstrated in several multicenter, randomized, clinical trials. 7,8,18 Currently, the therapeutic approach for preventing future ischemic events, including CEA, carotid artery stenting (CAS), and medical treatment, is decided primarily based on the percentage of luminal narrowing of the vessel. However, it has been shown that thromboembolic mechanisms correlate strongly with ischemic events in carotid artery stenosis. 16,36 Thus, a method for evaluating the risk of thromboembolism might improve the ability to identify the actual high-risk patients who would benefit most from intervention. In recent studies, some investigators have reported that plaque with a lipid-rich necrotic core aBBreViatiONS BB = black blood; CAS = carotid artery stenting; CE = contrast enhanced; CEA = carotid endarterectomy; ERR = expansive remodeling ratio; ICA = internal carotid artery; IPH = intraplaque hemorrhage; rSI = relative plaque signal intensity; VD = vessel diameter. OBJectiVe Plaque characteristics and morphology are important indicators of plaque vulnerability. MRI-detected intraplaque hemorrhage has a great effect on plaque vulnerability. Expansive remodeling, which has been considered compensatory enlargement of the arterial wall in the progression of atherosclerosis, is one of the criteria of vulnerable plaque in the coronary circulation. The purpose of this study was risk stratification of carotid artery plaque through the evaluation of quantitative expansive remodeling and MRI plaque signal intensity. methOdS Both preoperative carotid artery T1-weighted axial and long-axis MR images of 70 patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were studied. The expansive remodeling ratio (ERR) was calculated from the ratio of the linear diameter of the artery at the thickest segment of the plaque to the diameter of the artery on the long-axis image. Relative plaque signal intensity (rSI) was also calculated from the axial image, and the patients were grouped as follows: Group A = rSI ≥ 1.40 and ERR ≥ 1.66; Group B = rSI < 1.40 and ERR ≥ 1.66; Group C = rSI ≥ 1.40 and ERR < 1.66; and Group D = rSI < 1.40 and ERR < 1.66. Ischemic events within 6 months were retrospectively evaluated in each group. reSultS Of the 70 patients, 17 (74%) in Group A, 6 (43%) in Group B, 7 (44%) in Group C, and 6 (35%) in Group D had ischemic events. Ischemic events were significantly more common in Group A than in Group D (p = 0.01). cONcluSiONS In the present series of patients with carotid artery stenosis scheduled for CEA or CAS, patients with plaque with a high degree of expansion of the vessel and T1 high signal intensity were at higher risk of ischemic events. The combined assessment of plaque characterization with MRI and morphological evaluation using ERR might be useful in risk stratification for carotid lesions, whic...

show abstract

“…For the CEA high risk case with vulnerable plaque, PercuSurge guardwire system was used since filter obstruction tends to occur in vulnerable plaque and may result in stroke [2,17]. The amount of debris was evaluated with area since the thickness of the debris was not able to measured on the slide.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiology of flow impairment during carotid artery stenting with an embolus protection filter

et al. 2014

View full text Add to dashboard Cite

Objective: Carotid artery stenting (CAS) is a well-accepted treatment for atherosclerotic stenosis of carotid arteries. Since the occurrence of distal embolization with CAS is still major concern, embolus protection device is usually employed during the procedure. We examined the two types of embolus protection filters (Angioguard XP; AG, Filterwire EZ; FW) and evaluated each function. Thus, the filter was examined postoperatively and the cause of intraoperative flow impairment was evaluated. Results: Microscopical observation of the slide revealed that the pore density of FW was 1.5 times higher than that of AG, and filter area of FW was 2.5 times wider than that of AG. Materials and Methods

show abstract

Magnetic resonance plaque imaging to predict the occurrence of the slow-flow phenomenon in carotid artery stenting procedures

Abstract: Vulnerable carotid plaques have a significantly higher risk of slow-flow phenomenon than stable plaques. The occurrence of the slow-flow phenomenon can be predicted by MR plaque imaging before CAS.

Cited by 33 publications

References 41 publications

Safety of Protected Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis and Carotid Intraplaque Hemorrhage

Safety of Protected Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis and Carotid Intraplaque Hemorrhage

Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity

Pathophysiology of flow impairment during carotid artery stenting with an embolus protection filter

Contact Info

Product

Resources

About