Katsutoshi Takayama MD, Presenter: Nothing to Disclose

Kaoru Myouchin MD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Nakagawa MD, Abstract Co-Author: Nothing to Disclose

Toshiaki Taoka MD, Abstract Co-Author: Nothing to Disclose

Takeshi Wada MD, Abstract Co-Author: Nothing to Disclose

Masahiko Sakamoto, Abstract Co-Author: Nothing to Disclose

Kimihiko Kichikawa MD, Abstract Co-Author: Nothing to Disclose

Shinichiro Kurokawa, Abstract Co-Author: Nothing to Disclose

Our purpose is to investigate the feasibility of magnetic resonance (MR) plaque imaging to predict the high risk lesion for ischemic complication during carotid artery stenting (CAS) using filter embolic protection device (EPD).

Seventy five carotid artery stenotic lesions in 70 patients before CAS (62 male and eight female; median age, 72.2 years) were evaluated by MR plaque imaging with black blood T1 weighted images. The population consisted of 45.3 % symptomatic stenosis more than 50% at the common or internal carotid artery (ICA), and 54.7 % asymptomatic stenosis more than 80% stenosis. All CAS procedures were performed by standard procedure using filter EPD (Angioguard XP). Main plaque components were classified into unstable plaque (intraplaque hemorrhage and lipid-rich/necrotic core) and stable (fibrous tissue and dense calcification) from the signal pattern. Development of new ischemic lesions on diffusion-weighted imaging (DWI) was assessed within 48 hours after CAS.　We made statistical assessment on the plaque classification and the number of new ischemic lesions.

Technical success with the CAS procedures was achieved in 75(100%) of 75 procedures. Ipsilateral new ischemic lesions were observed in 25 CAS procedures (33.3%). Ipsilateral multiple ischemic lesions (>10) were observed in seven CAS procedures (6.7%). In 5 patients with multiple ischemic lesions, 2 showed minor strokes, 2 showed TIA, and 1 was asymtopmatic. New ischemic lesions except multiple ischemic lesions were all asymtopmatic. There was no significant difference between unstable and stable plaque about the presence of new ischemic lesion. However, multiple ischemic lesions occurred significantly (P < 0.01) more frequently in patients with unstable plaque.

Presence of unstable carotid plaques showed a higher risk of ischemic complication of CAS with filter EPD than stable plaques.

MR plaque imaging can demostrate high risk lesion of precedual ischemic complication of carotid artery stetning and is recommended as part of a MR study prior to carotid artery stenting.

Takayama, K, Myouchin, K, Nakagawa, H, Taoka, T, Wada, T, Sakamoto, M, Kichikawa, K, Kurokawa, S, Prediction of Periprocedural Ischemic Complication in Carotid Artery Stenting with Filter Embolic Protection Device (Angioguard XP): Feasibility of Magnetic Resonance (MR) Plaque Imaging—Single Center Study.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007367.html