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Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy

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...

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Autores principales: Lee, Eun‐Jae, Cho, Yong‐Pil, Lee, Sang‐Hun, Lee, Ji Sung, Nam, Hyo Jung, Kim, Bum Joon, Kwon, Tae‐Won, Kang, Dong‐Wha, Kim, Jong S., Kwon, Sun U.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121513/
https://www.ncbi.nlm.nih.gov/pubmed/27702804
http://dx.doi.org/10.1161/JAHA.116.004153
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author Lee, Eun‐Jae
Cho, Yong‐Pil
Lee, Sang‐Hun
Lee, Ji Sung
Nam, Hyo Jung
Kim, Bum Joon
Kwon, Tae‐Won
Kang, Dong‐Wha
Kim, Jong S.
Kwon, Sun U.
author_facet Lee, Eun‐Jae
Cho, Yong‐Pil
Lee, Sang‐Hun
Lee, Ji Sung
Nam, Hyo Jung
Kim, Bum Joon
Kwon, Tae‐Won
Kang, Dong‐Wha
Kim, Jong S.
Kwon, Sun U.
author_sort Lee, Eun‐Jae
collection PubMed
description 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. 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). 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.
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spelling pubmed-51215132016-12-06 Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy Lee, Eun‐Jae Cho, Yong‐Pil Lee, Sang‐Hun Lee, Ji Sung Nam, Hyo Jung Kim, Bum Joon Kwon, Tae‐Won Kang, Dong‐Wha Kim, Jong S. Kwon, Sun U. J Am Heart Assoc Original Research 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. 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). 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. John Wiley and Sons Inc. 2016-10-04 /pmc/articles/PMC5121513/ /pubmed/27702804 http://dx.doi.org/10.1161/JAHA.116.004153 Text en © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Lee, Eun‐Jae
Cho, Yong‐Pil
Lee, Sang‐Hun
Lee, Ji Sung
Nam, Hyo Jung
Kim, Bum Joon
Kwon, Tae‐Won
Kang, Dong‐Wha
Kim, Jong S.
Kwon, Sun U.
Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy
title Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy
title_full Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy
title_fullStr Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy
title_full_unstemmed Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy
title_short Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy
title_sort hemodynamic tandem intracranial lesions on magnetic resonance angiography in patients undergoing carotid endarterectomy
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121513/
https://www.ncbi.nlm.nih.gov/pubmed/27702804
http://dx.doi.org/10.1161/JAHA.116.004153
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