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Associations Between Carotid Plaque Characteristics and Improvement of Cerebral Blood Perfusion in Patients With Moderate to Severe Carotid Stenosis Undergoing Carotid Endarterectomy
Author(s) -
Huo Ran,
Xu Huimin,
Yang Dandan,
Qiao Huiyu,
Li Jin,
Han Hualu,
Liu Ying,
Wang Tao,
Yuan Huishu,
Zhao Xihai
Publication year - 2021
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.27365
Subject(s) - medicine , carotid endarterectomy , cerebral blood flow , stenosis , cardiology , radiology
Background The relationship between plaque characteristics and their predictive value for perioperative cerebral blood flow (CBF) are unknown. Purpose To investigate the relationship between carotid plaque characteristics and perioperative CBF utilizing MRI. Study Type Prospective. Population In all, 131 patients with carotid moderate‐to‐severe stenosis referred for carotid endarterectomy (CEA). Field Strength/Sequence 3T, black‐blood T 1 ‐ and T 2 ‐weighted, 3D time‐of‐flight, and simultaneous noncontrast angiography intraplaque hemorrhage. Assessment The relative CBF (rCBF = CBF index‐hemisphere /CBF contralateral‐hemisphere ) and the CBF difference ratio (DR CBF = [CBF post‐CEA – CBF pre‐CEA ]/CBF pre‐CEA ) in the middle cerebral artery territory were measured. The pre‐ and post‐CEA CTP data were used as the assessment standard for CBF change. Carotid lipid‐rich necrotic core (LRNC), intraplaque hemorrhage, calcification, fibrous cap rupture, maximum wall thickness, normalized wall index (NWI), and stenosis were determined. Statistical Tests Pearson or Spearman correlation, Mann–Whitney U ‐test, and linear regression. Results Patients with LRNC had higher rCBF pre‐CEA than those without (1.0 ± 0.1 vs. 0.9 ± 0.1, P < 0.05). NWI was weakly correlated with rCBF pre‐CEA ( r = −0.213, P < 0.05) and DR CBF ( r = 0.185, P < 0.05) and marginally correlated with rCBF post‐CEA ( r = 0.166, P = 0.057). LRNC was weakly correlated with rCBF pre‐CEA ( r = 0.179, P < 0.05). NWI was associated with rCBF pre‐CEA (β = −0.035; 95% confidence interval [CI] [−0.064, −0.006]; P < 0.05), rCBF post‐CEA (β = 0.042; 95% CI [0.002, 0.081]; P < 0.05) and DR CBF (β = 0.105; 95% CI [0.026, 0.185]; P < 0.05). After adjusting for confounding factors, associations of NWI with rCBF post‐CEA (β = 0.059; 95% CI [0.016, 0.103]; P < 0.05) and DR CBF (β = 0.110; 95% CI [0.021, 0.199]; P < 0.05) remained statistically significant, while the association between NWI and rCBF pre‐CEA was no longer significant (β = −0.026; 95% CI [−0.058, 0.006]; P = 0.112).The associations of LRNC with rCBF pre‐CEA (β = 0.057; 95% CI [−0.0006, 0.114]; P = 0.052) and DR CBF (β = −0.157; 95% CI [−0.314, 0.001]; P = 0.051) were close to statistical significance. After adjusting for confounding factors, these associations were statistically significant (of LRNC vs. rCBF pre‐CEA : β = 0.060; 95% CI [0.003, 0.118]; P < 0.05; LRNC vs. DR CBF : β = −0.205; 95% CI [−0.375, −0.036]; P < 0.05). Data Conclusion Carotid plaque burden and components, particularly LRNC, might be effective indicators for CBF change following CEA. Level of Evidence 1 Technical Efficacy Stage 5