• Shinichi Yoshimura, Kiyofumi Yamada, Masanori Kawasaki, Takahiko Asano, Masayuki Kanematsu, Manabu Takamatsu, Akira Hara, and Toru Iwama.
• Department of Neurosurgery, Graduate School of Medicine, Gifu University, Yanagido, Gifu city, Gifu 501-1194, Japan. shinichiyoshimura@hotmail.com
• Stroke. 2011 Nov 1; 42 (11): 3132-7.

Background And PurposeA major disadvantage of carotid artery stenting (CAS) compared to carotid endarterectomy is the increased risk of cerebral embolism. Thus, establishing a simple method to discriminate fragile plaques on preoperative routine examination is important. The present study examined whether high-intensity signal (HIS) in the plaque on time-of-flight (TOF) MRA, performed for screening, can discriminate plaque at high risk for cerebral embolism during CAS.MethodsIn the 30 patients treated using carotid endarterectomy, relationships between pathological findings of the plaques and TOF-MRA findings were analyzed. In the 112 patients treated using CAS, postoperative ipsilateral ischemic lesions on diffusion-weighted imaging and periprocedural ischemic symptoms were analyzed.ResultsThe percentage area of intraplaque hemorrhage stained by glycophorin A was significantly larger in HIS-positive plaques (51.8%±9.8%) than in HIS-negative plaques (8.6%±9.4%; P<0.001). Postoperative ischemic lesions on diffusion-weighted imaging were more frequent in the HIS-positive plaques (25/38; 65.8%) than in the HIS-negative plaques (26/74; 35.1%; P=0.002). Periprocedural ischemic symptoms were more frequently observed in HIS-positive plaques (7/38; 18.4%) than in HIS-negative plaques (1/74; 1.4%; P=0.003). Multivariate logistic regression analysis identified HIS on TOF-MRA as an independent predictor of periprocedural ischemic symptoms (odds ratio, 15.08; 95% confidence interval, 1.76-129.0).ConclusionsHIS in the plaque on TOF-MRA performed for screening could discriminate plaques at high risk for cerebral embolism during CAS.

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