• Shinichi Yoshimura, Kiyofumi Yamada, Masanori Kawasaki, Takahiko Asano, Masayuki Kanematsu, Masafumi Miyai, Yukiko Enomoto, Yusuke Egashira, and Toru Iwama.
• Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: shinichiyoshimura@hotmail.com.
• J Stroke Cerebrovasc Dis. 2013 Oct 1; 22 (7): 1082-7.

BackgroundThe aim of this study was to elucidate the impact of treatment selection, either carotid stenting or endarterectomy, based on preoperative magnetic resonance (MR) plaque imaging on periprocedural events.MethodsA total of 205 consecutive patients with high-grade carotid artery stenosis scheduled for elective revascularization with stenting or endarterectomy were retrospectively analyzed. In period 1, 95 patients were treated regardless of preoperative plaque imaging. In period 2, 110 patients received time of flight MR angiography, and endarterectomy was selected when a high-intensity signal in the plaque was observed on MR angiography because it indicated an unstable plaque. Periprocedural clinical results and outcome at 30 days were analyzed.ResultsIn period 1, 5 patients (5.3%) were treated with endarterectomy and the other 90 patients (94.7%) were treated with stenting. In period 2, 35 patients (31.8%) were treated with endarterectomy and the other 75 patients (68.2%) were treated with stenting. Periprocedural adverse events, including any stroke, myocardial infarction, or death, were significantly more frequent in period 1 than in period 2 (9.5% v 1.8%; P = .034). Ischemic stroke was significantly reduced from period 1 to period 2 (7.4% v 0.9%; P = .043). Multivariate logistic regression analysis revealed "treatment selection by plaque imaging" was the only factor identified as an independent predictor of periprocedural events (P = .043).ConclusionsTreatment selection based on preoperative plaque imaging appears useful for reducing periprocedural events of carotid artery revascularizations.Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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