Carotid artery stenting based on plaque characteristics using magnetic resonance plaque imaging

Abstract

Objective: We report the usefulness of magnetic resonance (MR) plaque imaging for treatment planning of cervical carotid artery stenosis. Carotid plaque lesions that show high-signal intensity on T1 weighted black-blood magnetic resonance imaging (BB-MRI) are regarded as high risk indicators for carotid artery stenting (CAS). We believe carotid endarterectomy (CEA) should be performed in such cases. We retrospectively examined the outcome of CAS in patients with plaques assessed by BB-MRI.
Methods: We electively performed CAS in 78 cases between September 2002 and March 2010. We also used BB-MRI to quantitate carotid artery stenosis, assess plaque characteristics before treatment, and evaluate the relative overall signal intensity (roSI), which we defined as the ratio of signal intensity in carotid plaques to that in sternocleidomastoid muscles.
Results: The average roSI was 1.20±0.31 and markedly higher (>1.5) in 7 lesions (9.0%). Ipsilateral diffusion-weighted imaging showed that lesions were new in 23 cases (37.1%). Within 30 days after surgery, 2 patients (2.7%) experienced stroke and myocardial infarction and eventually died.
Conclusions: Non-invasive preoperative MR plaque imaging is useful for screening patients with a high risk for CAS, and this screening can ensure safe outcomes after CAS.