Abstract T P85: Restenosis after Carotid Endarterectomy and Preoperative Carotid Plaque Imaging
Introduction: The incidence of restenosis after carotid endarterectomy (CEA) and carotid artery stenting (CAS) was reported to be approximately 6% at two years after the procedure in the CREST study. Restenosis after CEA, rather than CAS, was more likely to be related to a recurrence of stroke. The correlation between the plaque composition and restenosis after CEA has been investigated in previous reports, but the relationship between restenosis after CEA and preoperative plaque imaging is still unclear.
Objective: We investigated the relationship between restenosis after CEA based on the preoperative plaque imaging.
Methods: One-hundred and eighty-four CEAs were performed from November 2005 to March 2009 in our institution. In this study cohort, we included the 41 cases (40 patients, 37 males, mean age ± SD, 70.7±6.3) who underwent 18F-FDG positron emission tomography (PET) and magnetic resonance (MR) imaging using 3D inversion-recovery -based T1-weighted imaging (magnetization-prepared rapid acquisition gradient-echo [MPRAGE]) before CEA. The signal intensity of the carotid artery plaque on MPRAGE sequences was classified as “high” when the intensity was more than 200% the value of the adjacent muscle. The PET findings were evaluated by the maximum standard uptake value (max SUV) and a high max SUV was defined as >1.74. We included patients who had undergone serial imaging studies (CT angiography; n=36, and/or ultrasonography; n=36) postoperatively. Restenosis was defined as >50% stenosis on a CT angiogram or a >200 cm/sec peak systolic velocity (PSV) on ultrasonography at the treated site.
Results: Overall, restenosis occurred in three cases (7.3%). A MPRAGE high signal was recognized in 31 cases (76%) and a high maxSUV was noted in 23 cases (56%). All three patients with restenosis had both high MPRAGE and high maxSUV values.
The group with MPRAGE high/maxSUV high (n=18) had a significantly higher incidence of restenosis after CEA than did the other groups (P=0.0420).
Conclusions: The incidence of restenosis after CEA is suspected to be higher when the plaque consists of a rich necrotic core/intraplaque hemorrhage and a high degree of inflammation.
Author Disclosures: N. Kobayashi: None. K. Sato: None. K. Yamauchi: None. D. Maruyama: None. D. Ishii: None. K. Morita: None. T. Satow: None. H. Kataoka: None. K. Iihara: None.
- © 2014 by American Heart Association, Inc.