Key result
Higher carotid plaque intensity and higher wall shear stress were associated with the development of microembolic signals during carotid endarterectomy.
Why the study?
Are wall shear stress and T1 plaque intensity associated with the development of microembolic signals during carotid endarterectomy in patients with severe internal carotid artery stenosis?
Observational (n=100)
Are wall shear stress and T1 plaque intensity associated with the development of microembolic signals during carotid endarterectomy in patients with severe internal carotid artery stenosis?
Combining wall shear stress calculated via computational fluid dynamics and T1 plaque intensity on MRI improves the prediction of microembolic signals during carotid endarterectomy.
Answers are grounded in this paper and cite their sources.
Wall shear stress and plaque intensity were associated with embolic signals in CEA; hypothesis-generating for imaging risk stratification pending prospective validation.
Background and Purpose- The frictional force because of blood flow may dislodge masses present on the surface of a plaque. Such frictional force is calculated as wall shear stress (WSS) using computational fluid dynamics. The aims of the present study were to determine whether, in addition to carotid plaque intensity on T1-weighted magnetic resonance (MR) imaging, WSS calculated using computational fluid dynamics analysis for carotid arteries is associated with development of an embolism during exposure of carotid arteries during carotid endarterectomy. Methods- One hundred patients with internal carotid artery stenosis (≥70%) underwent carotid plaque imaging with MR, and 54 patients with a vulnerable plaque (intraplaque hemorrhage or lipid/necrotic core) displayed as a high-intensity lesion underwent additional cervical 3-dimensional MR angiography. The maximum value of WSS within the most severe stenotic segment of the internal carotid artery was calculated using MR angiography. Transcranial Doppler monitoring of microembolic signals (MES) in the ipsilateral middle cerebral artery was performed during carotid endarterectomy. Results- Although none of the 46 patients with a nonvulnerable carotid plaque had MES during exposure of carotid arteries, 24 of the 54 patients with a vulnerable carotid plaque (44%) had MES. Logistic regression analysis showed that higher plaque intensity ( P=0.0107) and higher WSS ( P=0.0029) were significantly associated with the development of MES. When both cutoff points of plaque intensity and WSS in the receiver operating characteristic curves for predicting development of MES were combined, specificity (from 63% to 93%) and positive predictive value (from 66% to 90%) became greater than those for plaque intensity alone. Conclusions- In addition to carotid plaque intensity on T1-weighted MR imaging, WSS calculated using computational fluid dynamics analysis for carotid arteries is associated with development of an embolism during exposure of carotid arteries during carotid endarterectomy.
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Oshida et al. (2018) conducted an observational in Internal carotid artery stenosis (n=100). Vulnerable carotid plaque and high wall shear stress vs. Nonvulnerable carotid plaque was evaluated on Development of microembolic signals (MES) during exposure of carotid arteries (p=0.0029). Higher carotid plaque intensity and higher wall shear stress were associated with the development of microembolic signals during carotid endarterectomy.
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