Multidetector computed tomography in the assessment of neurologic complications after carotid endarterectomy

Cover Page


Cite item

Full Text

Abstract

Rationale: Carotid endarterectomy is a surgical procedure to prevent acute ischemic cerebrovascular accidents. Neurologic complications can occur after surgery. Multidetector computed tomography (MDCT) is used for their diagnosis in severely ill patients.

Aim: To evaluate the potential of MDCT in the diagnosis of neurologic complications after carotid endarterectomy.

Materials and methods: We analyzed the results of radiologic assessments in 15 patients with early postoperative neurologic complications which occurred after surgery for internal carotid artery occlusion (595 patients underwent surgery). In stable patients, brain magnetic resonance imaging (MRI) was performed (T1, T2, FLAIR, DWI modes) with non-contrast MR angiography. In critically ill patients, brain computed tomography, computed tomographic angiography and perfusion computed tomography were performed.

Results: Ischemic neurologic complications were found in 11 patients. One patient had no clinical manifestation of an ischemic stroke, and acute stage signs were found in his routine brain MDCT. In 9 patients with acute brain ischemia, MDCT (n = 6) and MRI (n = 3) results were specific for this diagnosis, with no diagnostic problems. There were problems with the diagnosis of the hyperacute ischemia in 1 patient. In this patient, the complication occurred against a background of abnormal carotid blood flow before surgery, therefore, differential diagnosis between the hyperperfusion syndrome on the intervention side and the hyperacute phase of ischemic insult on the opposite side was performed. Hyperperfusion syndrome and hemorrhagic strokes were observed in 4 patients.

Conclusion: The most difficult for diagnosis by MDCT is the hyperacute phase of brain ischemia. Further studies are necessary in the area of diagnosis of postoperative complications, with the search for potential specific diagnostic criteria.

About the authors

M. V. Vishnyakova Jr.

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: cherridra@mail.ru

MD, PhD, Senior Research Fellow, Department of Roentgenology

61/2–15 Shchepkina ul., Moscow, 129110, Russian Federation. Tel.: +7 (495) 631 72 07

Russian Federation

R. N. Lar'kov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, PhD, Head of Department of Vascular and Ischemic Heart Disease Surgery

61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Russian Federation

M. V. Vishnyakova

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, PhD, Head of Department of Roentgenology

61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Russian Federation

References

  1. Национальные рекомендации по ведению пациентов с заболеваниями брахиоцефальных артерий. Ангиология и сосудистая хирургия. 2013;19(2 Прилож):1–73.
  2. Верещагин НВ. Роль поражений экстракраниальных отделов магистральных отделов головы в патогенезе нарушений мозгового кровообращения. В: Шмидт ЕВ, ред. Сосудистые заболевания нервной системы: новые методы диагностики в неврологии. Смоленск; 1980. с. 23–6.
  3. Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK; Society for Vascular Surgery. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011;54(3):e1–31. doi: 10.1016/j.jvs.2011.07.031.
  4. Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, Biasi G, Norgren L; ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J VascEndovasc Surg. 2009;37(4 Suppl):1–19. doi: 10.1016/j.ejvs.2008.11.006.
  5. Мамедов ФР, Арутюнов НВ, Усачев ДЮ, Лукшин ВА, Мельникова-Пицхелаури ТВ, Фадеева ЛМ, Пронин ИН, Корниенко ВН. Современные методы нейровизуализации при стенозирующей и окклюзирующей патологии сонных артерий. Лучевая диагностика и терапия. 2012;3(3): 109–16.
  6. Усачев ДЮ, Лукшин ВА, Яковлев СБ, Арустамян СР, Шмигельский АВ. Протокол обследования и хирургического лечения больных со стенозирующими поражениями магистральных артерий головного мозга. Вопросы нейрохирургии им. Н.Н. Бурденко. 2009;(2): 48–54.
  7. Мамедов ФР, Арутюнов НВ, Усачев ДЮ, Мельникова-Пицхелаури ТВ, Пяшина ДВ, Фадеева ЛМ, Корниенко ВН. Комплексная нейрорадиологическая диагностика при атеросклеротическом поражении сонных артерий. Вестник рентгенологии и радиологии. 2011;(1): 4–10.
  8. Вишнякова МВ (мл.), Ларьков РН, Вишнякова МВ. Возможности мультиспиральной компьютерной томографии в оценке состояния сонных артерий после реконструктивных операций. Альманах клинической медицины. 2015;(43): 11–8. doi: 10.18786/2072-0505-2015-43-11-18.
  9. Menon BK, Campbell BC, Levi C, Goyal M. Role of imaging in current acute ischemic stroke workflow for endovascular therapy. Stroke. 2015;46(6): 1453–61. doi: 10.1161/STROKEAHA.115.009160.
  10. Heit JJ, Wintermark M. Perfusion computed tomography for the evaluation of acute ischemic stroke: strengths and pitfalls. Stroke. 2016;47(4): 1153–8. doi: 10.1161/STROKEAHA.116.011873.
  11. North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, Fox AJ, Rankin RN, Hachinski VC, Wiebers DO, Eliasziw M. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7): 445–53. doi: 10.1056/NEJM199108153250701.
  12. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351(9113): 1379–87. doi: https://doi.org/10.1016/S0140-6736(97)09292-1.
  13. Стрелкова ТВ, Айроян АГ. Церебральный гиперперфузионный синдром. Клиническая физиология кровообращения. 2015;(3): 5–16.
  14. Feiwell RJ, Besmertis L, Sarkar R, Saloner DA, Rapp JH. Detection of clinically silent infarcts after carotid endarterectomy by use of diffusion- weighted imaging. AJNR Am J Neuroradiol. 2001;22(4): 646–9.
  15. Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ, Macdonald S, Gaines PA, Waaijer A, Stierli P, Jäger HR, Lyrer PA, Kappelle LJ, Wetzel SG, van der Lugt A, Mali WP, Brown MM, van der Worp HB, Engelter ST; ICSS-MRI study group. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol. 2010;9(4): 353–62. doi: 10.1016/S1474-4422(10)70057-0.
  16. Fiebach JB, Schellinger PD, Jansen O, Meyer M, Wilde P, Bender J, Schramm P, Jüttler E, Oehler J, Hartmann M, Hähnel S, Knauth M, Hacke W, Sartor K. CT and diffusion-weighted MR imaging in randomized order: diffusion- weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke. 2002;33(9): 2206–10. doi: https://doi.org/10.1161/01.STR.0000026864.20339.CB.
  17. de Lucas EM, Sánchez E, Gutiérrez A, Mandly AG, Ruiz E, Flórez AF, Izquierdo J, Arnáiz J, Piedra T, Valle N, Bañales I, Quintana F. CT protocol for acute stroke: tips and tricks for general radiologists. Radiographics. 2008;28(6): 1673–87. doi: 10.1148/rg.286085502.
  18. Latchaw RE, Alberts MJ, Lev MH, Connors JJ, Harbaugh RE, Higashida RT, Hobson R, Kidwell CS, Koroshetz WJ, Mathews V, Villablanca P, Warach S, Walters B; American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, and the Interdisciplinary Council on Peripheral Vascular Disease. Recommendations for imaging of acute ischemic stroke: a scientific statement from the American Heart Association. Stroke. 2009;40(11): 3646–78. doi: 10.1161/STROKEAHA.108.192616.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2017 Vishnyakova Jr. M.V., Lar'kov R.N., Vishnyakova M.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies