AUTHOR=Andereggen Lukas , Amin-Hanjani Sepideh , Beck Jürgen , Luedi Markus M. , Gralla Jan , Schubert Gerrit A. , Tortora Angelo , Andres Robert H. , Arnold Marcel , Raabe Andreas , Reinert Michael 

TITLE=Prediction of Long-Term Restenosis After Carotid Endarterectomy Using Quantitative Magnetic Resonance Angiography

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.862809

DOI=10.3389/fneur.2022.862809

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>To detect restenosis after carotid endarterectomy (CEA), long-term monitoring is required. However, non-selective follow-up is controversial and can be limited by costs and logistical considerations.</p></sec><sec><title>Objective</title><p>To examine the value of immediate perioperative vessel flow measurements after CEA using quantitative magnetic resonance angiography (QMRA) to detect patients at risk of long-term restenosis.</p></sec><sec><title>Methods</title><p>A prospective cohort study with long-term sonographic follow-up after CEA for symptomatic internal carotid artery stenosis (ICAs) &gt; 50%. In all patients, vessel flow has been assessed both pre- and postoperatively using QMRA within ±3 days of surgery. Data on QMRA assessment were analyzed to identify patients at risk of restenosis for up to 10 years.</p></sec><sec><title>Results</title><p>Restenosis was recorded in 4 of 24 patients (17%) at a median follow-up of 6.8 ± 2.6 years. None of them experienced an ischemic event. Perioperative flow differences were significantly greater in patients without long-term restenosis, both for the ipsilateral ICA (<italic>p</italic> &lt; 0.001) and MCA (<italic>p</italic> = 0.03), compared to those with restenosis (<italic>p</italic> = 0.22 and <italic>p</italic> = 0.3, respectively). The ICA mean flow ratio (<italic>p</italic> = 0.05) tended to be more effective than the MCA ratio in predicting restenosis over the long term (<italic>p</italic> = 0.35).</p></sec><sec><title>Conclusion</title><p>Our preliminary findings suggest that QMRA-based mean flow increases after CEA may be predictive of restenosis over the long term. Perioperative QMRA assessment could become an operator-independent screening tool to identify a subgroup of patients at risk for restenosis, in whom long-term monitoring is advised.</p></sec>