Fluorine-18-fluorodeoxyglucose positron emission tomography may predict the outcome in patients with asymptomatic mild stenosis of internal carotid artery--case report.
A 47-year-old male presented with asymptomatic mild (45%) internal carotid artery (ICA) stenosis associated with familial hypercholesterolemia. Fluorine-18-fluorodeoxyglucose ([(18)F]FDG) positron emission tomography (PET) showed that the carotid plaque had high uptake of [(18)F]FDG on the initial scan. He was treated with antiplatelet agent, but subsequently developed retinal artery occlusion on the ipsilateral side. The patient safely underwent carotid endarterectomy (CEA). Histological examination revealed that the plaque was rich in lipids and activated macrophages. Previous large randomized clinical trials have clarified that CEA is an effective therapeutic option to reduce the risk for subsequent ischemic stroke in patients with severe (more than 70%) ICA stenosis. The case strongly suggests that [(18)F]FDG PET may be a useful modality to identify inflamed and/or vulnerable carotid plaque and may be useful to predict the risk for subsequent ischemic stroke even in patients with mild to moderate ICA stenosis (less than 70%).
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, Japan.
Hiroaki
H
Motegi
Satoshi
S
Kuroda
Naoki
N
Nakayama
Kenji
K
Hirata
Tohru
T
Shiga
Nagara
N
Tamaki
D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000473:pathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000628:therapy; D016894:Endarterectomy, Carotid / Q000379:methods; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011859:Radiography; D019275:Radiopharmaceuticals; D015356:Retinal Artery Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18