Magnetic Resonance Plaque Imaging to Predict the Occurrence of the Slow-flow Phenomenon in Carotid Artery Stenting Procedures

Overview

Journal Neuroradiology

Specialties Neurology
Radiology

Date 2009 Nov 26

PMID 19936732

Citations 14

Authors

Masahiko Sakamoto

Toshiaki Taoka

Hiroyuki Nakagawa

Katsutoshi Takayama

Takeshi Wada

Kaoru Myouchin

Toshiaki Akashi

Toshiteru Miyasaka

Akio Fukusumi

Satoru Iwasaki

Kimihiko Kichikawa

Affiliations

Soon will be listed here.

Abstract

Introduction: The purpose is to investigate the feasibility of magnetic resonance (MR) plaque imaging in predicting the arterial flow impairment (slow-flow phenomenon) during carotid artery stenting (CAS) using a filter-type protection device.

Methods: Thirty-one carotid artery stenotic lesions in 30 patients (28 men and two women; mean age, 71.8 years) were evaluated by MR plaque imaging with black blood T1- and T2-weighted and time-of-flight sequences before CAS. Main plaque components were classified as vulnerable (intraplaque hemorrhage and lipid-rich/necrotic core) or stable (fibrous tissue and dense calcification) from the signal pattern. The plaque classification was statistically compared with the occurrence of slow-flow phenomenon.

Results: The slow-flow phenomenon was observed in ten CAS procedures (five flow arrests and five flow reductions). Flow arrests consisted of four vulnerable and one stable plaque, and flow reductions consisted of four vulnerable and one stable plaque. The slow-flow phenomenon occurred significantly (P<0.01) more frequently in patients with vulnerable plaque.

Conclusions: 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.

Citing Articles

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Kotsugi M, Nakagawa I, Hatakeyama K, Park H, Sato F, Furuta T Neurol Med Chir (Tokyo). 2020; 60(10):499-506.

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References

Mofidi R, Crotty T, McCarthy P, Sheehan S, Mehigan D, Keaveny T . Association between plaque instability, angiogenesis and symptomatic carotid occlusive disease. Br J Surg. 2001; 88(7):945-50. DOI: 10.1046/j.0007-1323.2001.01823.x. View

Katzen B, Criado F, Ramee S, Massop D, Hopkins L, Donohoe D . Carotid artery stenting with emboli protection surveillance study: thirty-day results of the CASES-PMS study. Catheter Cardiovasc Interv. 2007; 70(2):316-23. DOI: 10.1002/ccd.21222. View

Jeziorska M, Woolley D . Local neovascularization and cellular composition within vulnerable regions of atherosclerotic plaques of human carotid arteries. J Pathol. 1999; 188(2):189-96. DOI: 10.1002/(SICI)1096-9896(199906)188:2<189::AID-PATH336>3.0.CO;2-N. View

Kastrup A, Groschel K, Nagele T, Riecker A, Schmidt F, Schnaudigel S . Effects of age and symptom status on silent ischemic lesions after carotid stenting with and without the use of distal filter devices. AJNR Am J Neuroradiol. 2007; 29(3):608-12. PMC: 8118866. DOI: 10.3174/ajnr.A0871. View

Siewiorek G, Wholey M, Finol E . In vitro performance assessment of distal protection devices for carotid artery stenting: effect of physiological anatomy on vascular resistance. J Endovasc Ther. 2007; 14(5):712-24. DOI: 10.1177/152660280701400517. View

Yuan C, Mitsumori L, Beach K, Maravilla K . Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. Radiology. 2001; 221(2):285-99. DOI: 10.1148/radiol.2212001612. View

Moreno P, Purushothaman K, Fuster V, Echeverri D, Truszczynska H, Sharma S . Plaque neovascularization is increased in ruptured atherosclerotic lesions of human aorta: implications for plaque vulnerability. Circulation. 2004; 110(14):2032-8. DOI: 10.1161/01.CIR.0000143233.87854.23. View

Angelini A, Reimers B, Della Barbera M, Sacca S, Pasquetto G, Cernetti C . Cerebral protection during carotid artery stenting: collection and histopathologic analysis of embolized debris. Stroke. 2002; 33(2):456-61. DOI: 10.1161/hs0202.102337. View

Takaya N, Yuan C, Chu B, Saam T, Polissar N, Jarvik G . Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation. 2005; 111(21):2768-75. DOI: 10.1161/CIRCULATIONAHA.104.504167. View

10.

Yamada N, Higashi M, Otsubo R, Sakuma T, Oyama N, Tanaka R . Association between signal hyperintensity on T1-weighted MR imaging of carotid plaques and ipsilateral ischemic events. AJNR Am J Neuroradiol. 2007; 28(2):287-92. PMC: 7977430. View

11.

Siewiorek G, Eskandari M, Finol E . The Angioguard embolic protection device. Expert Rev Med Devices. 2008; 5(3):287-96. PMC: 3064459. DOI: 10.1586/17434440.5.3.287. View

12.

Kim S, Roh H, Jeon P, Kim K, Lee K, Byun H . Cerebral ischemia detected with diffusion-weighted MR imaging after protected carotid artery stenting: comparison of distal balloon and filter device. Korean J Radiol. 2007; 8(4):276-85. PMC: 2627162. DOI: 10.3348/kjr.2007.8.4.276. View

13.

Saam T, Ferguson M, Yarnykh V, Takaya N, Xu D, Polissar N . Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol. 2004; 25(1):234-9. DOI: 10.1161/01.ATV.0000149867.61851.31. View

14.

Yuan C, Zhang S, Polissar N, Echelard D, Ortiz G, Davis J . Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation. 2002; 105(2):181-5. DOI: 10.1161/hc0202.102121. View

15.

Henry M, Amor M, Henry I, Klonaris C, Chati Z, Masson I . Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system. J Endovasc Surg. 2000; 6(4):321-31. DOI: 10.1177/152660289900600405. View

16.

Ota H, Yu W, Underhill H, Oikawa M, Dong L, Zhao X . Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study. Arterioscler Thromb Vasc Biol. 2009; 29(10):1696-701. PMC: 2750883. DOI: 10.1161/ATVBAHA.109.192179. View

17.

Davies M . Stability and instability: two faces of coronary atherosclerosis. The Paul Dudley White Lecture 1995. Circulation. 1996; 94(8):2013-20. DOI: 10.1161/01.cir.94.8.2013. View

18.

Di Stefano R, Felice F, Balbarini A . Angiogenesis as risk factor for plaque vulnerability. Curr Pharm Des. 2009; 15(10):1095-106. DOI: 10.2174/138161209787846892. View

19.

Corti R, Fuster V, Fayad Z, Worthley S, Helft G, Smith D . Lipid lowering by simvastatin induces regression of human atherosclerotic lesions: two years' follow-up by high-resolution noninvasive magnetic resonance imaging. Circulation. 2002; 106(23):2884-7. DOI: 10.1161/01.cir.0000041255.88750.f0. View

20.

Rapp J, Wakil L, Sawhney R, Pan X, Yenari M, Glastonbury C . Subclinical embolization after carotid artery stenting: new lesions on diffusion-weighted magnetic resonance imaging occur postprocedure. J Vasc Surg. 2007; 45(5):867-72. DOI: 10.1016/j.jvs.2006.12.058. View