Quantitative evaluation using the plaque/muscle ratio index panels predicts plaque type and risk of embolism in patients undergoing carotid artery stenting

Takemoto, Koichiro; Ueba, Tetsuya; Takano, Koichi; Abe, Hiroshi; Hirata, Yoko; Higashi, Toshio; Inoue, Tatsuo; Sakata, Noriyuki; Yoshimitsu, Kengo

doi:10.1016/j.clineuro.2012.12.001

Cited by 18 publications

(5 citation statements)

References 37 publications

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“…Seventy-nine studies were excluded for the following reasons: MRI to detect cerebral ischaemia did not include DWI sequences, or DWI was not done in all patients (n = 15); 22–36 no DWI was performed before treatment (n = 11); 37–47 post-procedural DWI was performed more than seven days after treatment (n = 3); 48–50 the number of DWI+ patients or procedures could not be extracted (n = 6); 51–56 or information on procedural stroke was lacking or patients with procedural stroke were excluded from the analysis (n = 6). 49,57–68 One study was excluded because the analysis was restricted to patients with available six months’ follow-up who constituted less than half of the study population (n = 1). 69 One study was excluded since only pre-selected groups of patients showing micro-embolic signals in transcranial Doppler during CEA were included in the final analysis.…”

Section: Resultsmentioning

confidence: 99%

Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis

Traenka

Engelter

Brown³

et al. 2019

European Stroke Journal

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Aim: To investigate whether lesions on diffusion-weighted imaging (DWIþ) after carotid artery stenting (CAS) or endarterectomy (CEA) might provide a surrogate outcome measure for procedural stroke. Materials and Methods: Systematic MedLine V R database search with selection of all studies published up to the end of 2016 in which DWI scans were obtained before and within seven days after CAS or CEA. The correlation between the underlying log odds of stroke and of DWIþ across all treatment groups (i.e. CAS or CEA groups) from included studies was estimated using a bivariate random effects logistic regression model. Relative risks of DWIþ and stroke in studies comparing CAS vs. CEA were estimated using fixed-effect Mantel-Haenszel models. Results: We included data of 4871 CAS and 2099 CEA procedures (85 studies). Across all treatment groups (CAS and CEA), the log odds for DWIþ was significantly associated with the log odds for clinically manifest stroke (correlation coefficient 0.61 (95% CI 0.27 to 0.87), p ¼ 0.0012). Across all carotid artery stenting groups, the correlation coefficient was 0.19 (p ¼ 0.074). There were too few CEA groups to reliably estimate a correlation coefficient in this subset alone. In 19 studies comparing CAS vs. CEA, the relative risks (95% confidence intervals) of DWIþ and stroke were 3.83 (3.17-4.63, p < 0.00001) and 2.38 (1.44-3.94, p ¼ 0.0007), respectively. Discussion: This systematic meta-analysis demonstrates a correlation between the occurrence of silent brain infarcts on diffusion-weighted imaging and the risk of clinically manifest stroke in carotid revascularisation procedures. Conclusion: Our findings strengthen the evidence base for the use of DWI as a surrogate outcome measure for procedural stroke in carotid revascularisation procedures. Further randomised studies comparing treatment effects on DWI lesions and clinical stroke are needed to fully establish surrogacy.

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Section: Resultsmentioning

confidence: 99%

Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis

Traenka

Engelter

Brown³

et al. 2019

European Stroke Journal

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“…These results suggest that a high T1W-SIR plaque mainly consists of IPH and not lipid. A recent study reported that a higher T1W-SIR was more often present in symptomatic patients with lesions positive for cerebral ischemia on DWI [20]. In addition, Kurosaki et al [21] reported that plaques with higher T1W-SIR were at higher risk of causing ischemic events.…”

Section: Discussionmentioning

confidence: 99%

Lipid Core Burden Index Assessed by Near-Infrared Spectroscopy of Symptomatic Carotid Plaques: Association with Magnetic Resonance T1-Weighted Imaging

Nakagawa¹,

Kotsugi²,

Park³

et al. 2021

Cerebrovasc Dis

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Introduction: Vulnerable plaques are a strong predictor of cerebrovascular ischemic events, and high lipid core plaques (LCPs) are associated with an increased risk of embolic infarcts during carotid artery stenting (CAS). Recent developments in magnetic resonance (MR) plaque imaging have enabled noninvasive assessment of carotid plaque vulnerability, and the lipid component and intraplaque hemorrhage (IPH) are visible as high signal intensity areas on T1-weighted MR images. Recently, catheter-based near-infrared spectroscopy (NIRS) has been shown to accurately distinguish LCPs without IPH. This study aimed to determine whether the results of assessment of high LCPs by catheter-based NIRS correlate with the results of MR plaque imaging. Methods: We recruited 82 consecutive symptomatic carotid artery stenosis patients who were treated with CAS under NIRS and MR plaque assessment. Maximum lipid core burden index (max-LCBI) at minimal luminal areas (MLA), defined as max-LCBIMLA, and max-LCBI for any 4-mm segment in a target lesion, defined as max-LCBIAREA, were assessed by NIRS. Correlations were investigated between max-LCBI and MR T1-weighted plaque signal intensity ratio (T1W-SIR) and MR time-of-flight signal intensity ratio (TOF-SIR) in the same regions as assessed by NIRS. Results: Both T1W-SIRMLA and T1W-SIRAREA were significantly lower in the high LCP group (max-LCBI >504, p < 0.001 for both), while TOF-SIRMLA and TOF-SIRAREA were significantly higher in the high LCP group (p < 0.001 and p = 0.004, respectively). A significant linear correlation was present between max-LCBIMLA and both TIW-SIRMLA and TOF-SIRMLA (r = −0.610 and 0.452, respectively, p < 0.0001 for both). Furthermore, logistic regression analysis revealed that T1W-SIRMLA and TOF-SIRMLA were significantly associated with a high LCP assessed by NIRS (OR, 44.19 and 0.43; 95% CI: 6.55–298.19 and 0.19–0.96; p < 0.001 and = 0.039, respectively). Conclusions: A high LCP assessed by NIRS correlates with the signal intensity ratio of MR imaging in symptomatic patients with unstable carotid plaques.

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“…In contrast, previous studies that included patients both with and without carotid IPH also demonstrated the association between the T1-weighted signal of carotid plaque and cerebral ischemic lesions. Takemoto et al 29 reported that a higher T1weighted signal intensity of carotid plaque was present more often in symptomatic patients with lesions positive for cerebral ischemia on DWI. In a study of patients with carotid artery stenosis scheduled for carotid endarterectomy or carotid artery stenting, Kurosaki et al 30 documented that plaques with higher signal intensity on T1-weighted images were at higher risk of causing ischemic events.…”

Section: Discussionmentioning

confidence: 99%

Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct

Yang

Liu

Han

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Identifying the mere presence of carotid intraplaque hemorrhage would be insufficient to accurately discriminate the presence of acute cerebral infarct. We aimed to investigate the association between signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted MR imaging and acute cerebral infarct in patients with hemorrhagic carotid plaques using MR vessel wall imaging. MATERIALS AND METHODS: Symptomatic patients with carotid intraplaque hemorrhage were included. The signal intensity ratios of carotid intraplaque hemorrhage against muscle on T1-weighted, TOF, and MPRAGE images were measured. The acute cerebral infarct was determined on the hemisphere ipsilateral to the carotid intraplaque hemorrhage. The association between signal intensity ratios of carotid intraplaque hemorrhage and acute cerebral infarct was analyzed. RESULTS: Of 109 included patients (mean, 66.8 6 9.9 years of age; 96 men), 40 (36.7%) had acute cerebral infarct. Patients with acute cerebral infarct had significantly higher signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted images than those without (

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Quantitative evaluation using the plaque/muscle ratio index panels predicts plaque type and risk of embolism in patients undergoing carotid artery stenting

Cited by 18 publications

References 37 publications

Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis

Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: A surrogate outcome measure for procedural stroke? A systematic review and meta-analysis

Lipid Core Burden Index Assessed by Near-Infrared Spectroscopy of Symptomatic Carotid Plaques: Association with Magnetic Resonance T1-Weighted Imaging

Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct

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