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Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2016 Oct 04; Vol. 5 (10). Date of Electronic Publication: 2016 Oct 04. - Publication Year :
- 2016
-
Abstract
- Background: Hemodynamic tandem intracranial lesions (TILs) on intracranial magnetic resonance angiography, which develop flow dependently, have been overlooked clinically in patients undergoing carotid endarterectomy. As they represent severe baseline hemodynamic compromise at the segment, they may be associated with distinctive clinical outcomes.<br />Methods and Results: We assessed 304 consecutive carotid endarterectomy cases treated over 3 years. Included cases had both preoperative and postoperative intracranial 3-dimensional time-of-flight magnetic resonance angiography, of which signal intensities are flow dependent, and postoperative diffusion-weighted imaging (≤3 days following carotid endarterectomy). Preoperative TILs in the ipsilateral intracranial arteries were evaluated by the presence of nonexclusive components: focal stenosis (>50%), diffuse stenosis (>50%), and decreased signal intensities (>50%). The components showing postoperative normalization were considered hemodynamic. TILs with hemodynamic components were defined as hemodynamic TILs, while others as consistent TILs. Baseline characteristics and postoperative outcomes were analyzed among 3 groups: no TILs, consistent TILs, and hemodynamic TILs. Preoperative TILs were identified in 104 (34.2%) cases; 54 (17.8%) had hemodynamic components. Diffuse stenosis and decreased signal intensities were usually reversed postoperatively. Patients with hemodynamic TILs tended to have severe proximal carotid stenosis and recent strokes (≤14 days). For the outcome, hemodynamic TILs were independently associated with the advent of postoperative ischemic lesions on diffusion-weighted imaging (odds ratio: 2.50; 95% CI, 1.20-5.20).<br />Conclusions: In patients undergoing carotid endarterectomy, a significant number of preoperative TILs demonstrated hemodynamic components, which were reversed postoperatively. The presence of such components was distinctively associated with the postoperative incidence of new ischemic lesions.<br /> (© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
- Subjects :
- Aged
Carotid Stenosis diagnostic imaging
Carotid Stenosis surgery
Cerebrovascular Circulation
Comorbidity
Constriction, Pathologic
Diffusion Magnetic Resonance Imaging
Female
Hemodynamics
Humans
Imaging, Three-Dimensional
Intracranial Arterial Diseases diagnostic imaging
Magnetic Resonance Angiography
Male
Middle Aged
Republic of Korea epidemiology
Treatment Outcome
Ultrasonography, Doppler
Brain Ischemia epidemiology
Carotid Stenosis epidemiology
Endarterectomy, Carotid
Intracranial Arterial Diseases epidemiology
Postoperative Complications epidemiology
Stroke epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 5
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 27702804
- Full Text :
- https://doi.org/10.1161/JAHA.116.004153