Zsuzsanna Mihály1, Ádám Molnár1, Bálint Szilveszter2, Alexisz Panajotu2, Ferenc Suhai2, Pál Maurovich-Horvath2, Entz László1, Péter Sótonyi1
1 Department of Vascular Surgery Heart and Vascular Centre Semmelweis University
2 Cardiovascular Imaging Research Group Department of Cardiology Heart and Vascular Centre Semmelweis University
Introduction: According to the current clinical guidelines the indication for any intervention on carotid artery stenosis is a minimum 70% grade diameter stenosis. The perioperative risk of stroke of carotid artery endarterectomy is around 2%. Clinical decisions may be altered if any plaque features could be identified to be responsible for elevated risk of cerebral ischaemia. Currently, there are no imaging technique is widely accepted and used clinically to predict potential higher stroke risk.
Aims: Our aim is prediction of potentially increased risk of cerebral ischaemia caused by plaque instability based on the correlation of plaque components and relevant cerebral ischaemic lesions on preoperative head MRI.
Methods: Asymptomatic and symptomatic patients with high grade carotid artery stenosis operated at Semmelweis University between 01.01.2016 and 30.05.2017 were enrolled to the study. Enrollment criteria were the preoperative protocolized CTA by Philips Brilliance iCT and the consent to the preoperative MRI. The CTA imaging of the plaques were analysed by Medis AngioQ software. The cerebral ischemic lesions in MRI were classified by the Fazekas-scale (0-3). The statistical analysis was performed by SPSS software.
Results: During the study period out of 471 operated patients 60 fulfilled all the enrollment criteria. In 60 cases the CTA plaque analysis and MRI Fazakas-scale classification were performed. There was a significant correlation (p=0.047) between the higher volume of necrotic component ratio and the higher incidence of relevant ischemic lesions according to the univariate linear regression analysis.
Conclusion: Our results suggest that the higher ratio of necrotic components (based on CTA plaque analysis) could significantly increase the incidence of relevant side cerebral ischaemic lesions (classified by Fazekas-scale). Based on these findings the asymptomatic patients with high necrotic component ratio have higher risk of cerebral ischaemia thus should be operated more urgently.
Doctoral School:Basic and Translation Medicine
Program: Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Supervisor: László Entz Prof MD
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