title: Association between carotid plaque composition assessed by multidetector computed tomography and cerebral embolism after carotid stenting.
abstract: BACKGROUND
  We aimed to assess the relationship between atherosclerotic carotid plaque composition analyzed using multidetector computed tomography (MDCT) and the appearance of new ischemic lesions detected by diffusion-weighted images (DWI) after carotid artery stenting (CAS).
  
  
  METHODS
  We quantitatively and qualitatively analyzed plaque characteristics in carotid arteries using MDCT before CAS in 19 patients. Carotid plaques were expediently subdivided into four components with Hounsfield unit (HU) values of <0, 0-60, 60-130, and >600. The incidence of distal embolism was evaluated with DWI. Pearson's correlation analyses were used to assess the association between plaque composition and the incidence of cerebral embolization.
  
  
  RESULTS
  Fifteen patients (79%) demonstrated new DWI lesions after CAS. High-signal DWIs were noted as follows: one in six patients, 2 ~ 5 in five patients, 6 ~ 10 in two patients, and >10 in two patients. The mean volumes of the plaque components for HU < 0, 0-60, 60-130, and >600 were 5.4, 200, 260, and 59 mm(3), respectively. There was a strong correlation between the number of high-signal DWI lesions in the ipsilateral side and the plaque volume of HU < 0 (r = 0.927; P < 0.0001). There was a moderate correlation between the number of high-signal DWI lesions and the plaque volume of HU 0-60 (r = 0.568; P = 0.0099) and the sum total of HU < 0 and HU 0-60 (r = 0.609; P = 0.0047).
  
  
  CONCLUSIONS
  Quantitative and qualitative tissue characterization of carotid plaques using MDCT might be a useful predictor for silent ischemic lesions after CAS.
authors.affiliation: Department of Neurosurgery and Radiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. uchiyama@ns.m.kanazawa-u.ac.jp
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uchiyama
authors.forename: Kouichi
authors.initials: K
authors.lastname: Misaki
authors.forename: Masanao
authors.initials: M
authors.lastname: Mohri
authors.forename: Takuya
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hirota
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Ueda
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy*; D015897:Comorbidity; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging*; D015607:Stents