Carotid intraplaque hemorrhage detected by magnetic resonance imaging predicts embolization during carotid endarterectomy.
BACKGROUND
Microembolization detected during the dissection phase of carotid endarterectomy (CEA) is associated with plaque instability and might be associated with perioperative morbidity. Intraplaque hemorrhage is found in unstable plaques and is detectable using magnetic resonance imaging (MRI). We aimed to ascertain whether intraplaque hemorrhage as seen on carotid MRI predicts particulate embolization in the dissection phase of CEA.


METHODS
Patients with high-grade symptomatic carotid stenosis undergoing CEA were prospectively enrolled. All underwent preoperative MRI assessment of the carotid arteries for intraplaque hemorrhage and transcranial Doppler scanning during the dissection phase of the CEA to assess the presence of microembolic signals. Associations between intraplaque hemorrhage and intraoperative microembolic signals were studied.


RESULTS
Analysis was undertaken on 60 participants; of these, 36 (60%) showed ipsilateral carotid MRI intraplaque hemorrhage, and 24 (40%) did not. Microembolic signals were detected during the dissection phase in 23 (38.3%) participants, and 19 had MRI-detected intraplaque hemorrhage. The association between carotid intraplaque hemorrhage and the presence of dissection phase microembolic signals was significant (odds ratio [OR], 5.6; 95% confidence interval [CI], 1.6 to 19.7, P = .007), even after controlling for age, sex, individual surgeon, degree of stenosis, and delay from symptom to CEA (adjusted OR, 5.8; 95% CI, 1.1 to 30.4, P = .037).


CONCLUSIONS
Intraplaque hemorrhage as detected by carotid MRI predicts particulate embolization during the dissection phase of CEA. This imaging technique can be used to identify patients with increased intraoperative thromboembolic risk, and this could influence preventive strategies.
Altaf
Nishath
N
Department of Vascular and Endovascular Surgery, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom. nish.altaf@nottingham.ac.uk
Beech
Andrew
A
Goode
Stephen D
SD
Gladman
John R
JR
Moody
Alan R
AR
Auer
Dorothee P
DP
MacSweeney
Shane T
ST
D000368:Aged; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial