Abstract 2663: The Impact of Preoperative Magnetic Resonance Plaque Imaging on Treatment Results of Carotid Artery Stenosis
Background and Purpose: Selection of carotid artery stenting (CAS) or carotid endarterectomy (CEA) remains controversial. The aim of this study was to elucidate whether treatment selection based on preoperative magnetic resonance (MR) plaque imaging can improve treatment results of carotid artery stenosis.
Methods: A total of 205 consecutive patients with high-grade carotid artery stenosis scheduled for elective revascularization with CAS or CEA were analyzed. From 1 2004 to June 2007 (period I: 3.5 years), 95 patients were treated regardless of preoperative plaque imaging. From July 2007 to March 2011 (period II: 3.5 years), 110 patients received time-of-flight MR angiography (TOF-MRA), and CEA was basically selected when a high intensity signal (HIS) was observed on TOF-MRA (Fig.1a), because this finding indicates intraplaque hemorrahge (Fig.1b,c). Periprocedural clinical events and clinical outcome at 30 days later were analyzed.
Results: In period I, 5 patients (5.3%) were treated using CEA and the other 90 patients (94.7%) were treated with CAS (Table). In period II, 35 patients (31.8%) were treated with CEA and the other 75 patients (68.2%) were treated using CAS. Major adverse events including any stroke, myocardial infarction and death, were significantly more frequent in period I than in period II (9.5% vs 1.8%; p=0.034). Ischemic stroke was significantly reduced from period I to period II (7.4% vs 0.9%; p=0.043). In particular, a striking difference in incidence of stroke existed between the periods in HIS-positive plaques (21.7%, 2.0%, respectively; p=0.018, Fig.2).
Conclusions: Preoperative MR plaque imaging appears useful for improving treatment results of carotid artery stenosis when it was used for treatment selection.
- © 2012 by American Heart Association, Inc.