title: Selection of carotid artery stenting or endarterectomy based on magnetic resonance plaque imaging reduced periprocedural adverse events.
abstract: BACKGROUND
  The aim of this study was to elucidate the impact of treatment selection, either carotid stenting or endarterectomy, based on preoperative magnetic resonance (MR) plaque imaging on periprocedural events.
  
  
  METHODS
  A total of 205 consecutive patients with high-grade carotid artery stenosis scheduled for elective revascularization with stenting or endarterectomy were retrospectively analyzed. In period 1, 95 patients were treated regardless of preoperative plaque imaging. In period 2, 110 patients received time of flight MR angiography, and endarterectomy was selected when a high-intensity signal in the plaque was observed on MR angiography because it indicated an unstable plaque. Periprocedural clinical results and outcome at 30 days were analyzed.
  
  
  RESULTS
  In period 1, 5 patients (5.3%) were treated with endarterectomy and the other 90 patients (94.7%) were treated with stenting. In period 2, 35 patients (31.8%) were treated with endarterectomy and the other 75 patients (68.2%) were treated with stenting. Periprocedural adverse events, including any stroke, myocardial infarction, or death, were significantly more frequent in period 1 than in period 2 (9.5% v 1.8%; P = .034). Ischemic stroke was significantly reduced from period 1 to period 2 (7.4% v 0.9%; P = .043). Multivariate logistic regression analysis revealed "treatment selection by plaque imaging" was the only factor identified as an independent predictor of periprocedural events (P = .043).
  
  
  CONCLUSIONS
  Treatment selection based on preoperative plaque imaging appears useful for reducing periprocedural events of carotid artery revascularizations.
authors.affiliation: Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: shinichiyoshimura@hotmail.com.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshimura
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Yamada
authors.forename: Masanori
authors.initials: M
authors.lastname: Kawasaki
authors.forename: Takahiko
authors.initials: T
authors.lastname: Asano
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanematsu
authors.forename: Masafumi
authors.initials: M
authors.lastname: Miyai
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Enomoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Egashira
authors.forename: Toru
authors.initials: T
authors.lastname: Iwama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome