(Stroke. 2000;31:1824.)
© 2000 American Heart Association, Inc.
Original Contributions |
Silent Cerebral Ischemia Detected by Diffusion-Weighted MRI After Carotid Endarterectomy
From the Department of Neurosurgery (A.B., R.W.S.), University of Berne, Inselspital, DKNS, and the Division of Neuroradiology (L.R., K.-O.L., G.S.), University of Berne, Inselspital, DRNN, Berne Switzerland.
Correspondence to Alain Barth, MD, Department of Neurosurgery, University of Berne, DKNS, Inselspital, CH-3010 Berne, Switzerland. E-mail alain.barth{at}insel.ch
Background and Purpose—Small emboli arising from a friable plaque during carotid endarterectomy (CEA) constitute an important risk of perioperative ischemic complications. To evaluate the incidence and significance of silent cerebral ischemic lesions of embolic origin after CEA, we prospectively examined a series of surgical patients with high-grade carotid stenosis by using diffusion-weighted MRI (DWI). We also tried to correlate postoperative ischemic lesions with the occurrence of sonographic cerebral embolic signals, the presence of plaque ulcerations, and the use of intraoperative shunting.
Methods—Of a consecutive series of 53 patients undergoing elective CEA for high-grade carotid stenosis, 48 patients with unchanged postoperative neurological status were prospectively studied with DWI of the brain the day before and the day after the operation. The magnetic resonance images were analyzed by 2 neuroradiologists blinded to the clinical result of the operation. Any new hyperintense signal was interpreted as a postoperative ischemic lesion.
Results—Forty-six (95.8%) of 48 patients had unchanged postoperative brain DWI. In 2 patients (4.2%), a new single asymptomatic hyperintense signal was observed on the side of the operation. Both lesions were small and presumably of embolic origin. They were not related to sonographic embolic signals, plaque ulcerations, or intraoperative shunting.
Conclusions—These results suggest that the incidence of silent ischemic brain lesions of embolic origin after CEA is low and does not correlate with the occurrence of intraoperative sonographic microemboli. They confirm that CEA is a safe procedure that carries a low risk of postoperative cerebral events.
Key Words: carotid endarterectomy • carotid stenosis • cerebral embolism • magnetic resonance imaging, diffusion-weighted
This article has been cited by other articles:
 |
|
 |
|
  J. S. Yadav Assessing Carotid Revascularization: Should We Abandon the Neurological Examination? J. Am. Coll. Cardiol. Intv., October 1, 2008; 1(5): 578 - 579. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Schnaudigel, K. Groschel, S. M. Pilgram, and A. Kastrup New Brain Lesions After Carotid Stenting Versus Carotid Endarterectomy: A Systematic Review of the Literature Stroke, June 1, 2008; 39(6): 1911 - 1919. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Maleux, P. Demaerel, E. Verbeken, K. Daenens, S. Heye, F. Van Sonhoven, A. Nevelsteen, and G. Wilms Cerebral ischemia after filter-protected carotid artery stenting is common and cannot be predicted by the presence of substantial amount of debris captured by the filter device. AJNR Am. J. Neuroradiol., October 1, 2006; 27(9): 1830 - 1833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Asakura, K. Kawaguchi, H. Sakaida, N. Toma, S. Matsushima, K. Kuraishi, H. Tanemura, Y. Miura, M. Maeda, and W. Taki Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 753 - 758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Cosottini, M. C. Michelassi, M. Puglioli, G. Lazzarotti, G. Orlandi, F. Marconi, G. Parenti, and C. Bartolozzi Silent Cerebral Ischemia Detected With Diffusion-Weighted Imaging in Patients Treated With Protected and Unprotected Carotid Artery Stenting Stroke, November 1, 2005; 36(11): 2389 - 2393. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. G. Roh, H. S. Byun, J. W. Ryoo, D. G. Na, W.-J. Moon, B. B. Lee, and D.-I. Kim Prospective Analysis of Cerebral Infarction After Carotid Endarterectomy and Carotid Artery Stent Placement by Using Diffusion-Weighted Imaging AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 376 - 384. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Soinne, J. Helenius, E. Saimanen, O. Salonen, P. J. Lindsberg, M. Kaste, and T. Tatlisumak Brain diffusion changes in carotid occlusive disease treated with endarterectomy Neurology, October 28, 2003; 61(8): 1061 - 1065. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Schluter, T. Tubler, J. C. Steffens, D. G. Mathey, and J. Schofer Focal ischemia of the brain after neuroprotected carotid artery stenting J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1007 - 1013. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Barth and C. Bassetti Patient Selection for Carotid Endarterectomy: How Far Is Risk Modeling Applicable to the Individual? Stroke, February 1, 2003; 34(2): 524 - 527. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. M. van Heesewijk, J. A. Vos, E. S. Louwerse, J. C. van den Berg, T. T. C. Overtoom, S. M. P. G. Ernst, H. W. Mauser, F. L. Moll, and R. G. A. Ackerstaff New Brain Lesions at MR Imaging after Carotid Angioplasty and Stent Placement Radiology, August 1, 2002; 224(2): 361 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Angelini, B. Reimers, M. D. Barbera, S. Sacca, G. Pasquetto, C. Cernetti, M. Valente, P. Pascotto, and G. Thiene Cerebral Protection During Carotid Artery Stenting: Collection and Histopathologic Analysis of Embolized Debris Stroke, February 1, 2002; 33(2): 456 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. H. Brooks, R. R. McClure, M. R. Jones, T. C. Coleman, and L. Breathitt Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1589 - 1595. [Abstract] [Full Text] [PDF]
|
|