AUTHOR=Liu Ying , Huo Ran , Xu Huimin , Zhou Guangjin , Wang Tao , Yuan Huishu , Zhao Xihai 

TITLE=Associations Between Carotid Plaque Characteristics and Perioperative Cerebral Blood Flow Determined by Arterial Spin Labeling Imaging in Patients With Moderate-to-Severe Stenosis Undergoing Carotid Endarterectomy

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.899957

DOI=10.3389/fneur.2022.899957

ISSN=1664-2295

ABSTRACT=<sec><title>Purpose</title><p>To examine the associations between carotid plaque characteristics and perioperative cerebral blood flow (CBF) by arterial spin labeling (ASL) imaging.</p></sec><sec><title>Materials and Methods</title><p>Patients with unilateral moderate-to-severe carotid stenosis referred for carotid endarterectomy (CEA) were recruited and underwent carotid vessel wall and brain ASL magnetic resonance imaging. The following imaging features were measured: relative CBF (rCBF = CBF<sub>index−<italic>hemisphere</italic></sub>/CBF<sub>contralateral−<italic>hemisphere</italic></sub>) in the middle cerebral artery territory; plaque burden and the presence of lipid-rich necrotic core; intraplaque hemorrhage (IPH); calcification; ulcer and fibrous-cap rupture; and the volume and maximum plaque components' area percentages. The associations between plaque characteristics and perioperative CBF were analyzed.</p></sec><sec><title>Results</title><p>Sixty-one patients (mean age, 66.6 ± 7.8 years; 55 males) were included. Univariate linear regression showed that rCBF<sub>pre−CEA</sub> was associated with stenosis [β, −0.462; 95% confidence interval (CI), from −0.797 to −0.126; <italic>p</italic> = 0.008], calcification (β, 0.103; 95% CI, 0.005–0.201; <italic>p</italic> = 0.040), maximum IPH area percentage (β, −0.127; 95% CI, from −0.223 to −0.030; <italic>p</italic> = 0.012), and ulcer (β, 0.069; 95% CI, 0.025–0.113; <italic>p</italic> = 0.005); rCBF<sub>post−CEA</sub> was associated with the IPH volume (β, −0.060; 95% CI, from −0.107 to −0.014; <italic>p</italic> = 0.013). After adjusting for the confounding factors, the associations of calcification with rCBF<sub>pre−CEA</sub> (β, 0.099; 95% CI, from 0.004 to −0.194; <italic>p</italic> = 0.042) and IPH volume with rCBF<sub>post−CEA</sub> (β, −0.060; 95% CI, from −0.109 to −0.011; <italic>p</italic> = 0.020) remained statistically significant, while those of rCBF<sub>pre−CEA</sub> with maximum IPH area percentage (β, −0.089; 95% CI, from −0.188 to 0.011; <italic>p</italic> = 0.080) and ulcer (β, 0.050; 95% CI, from −0.012 to 0.112; <italic>p</italic> = 0.100) did not remain statistically significant.</p></sec><sec><title>Conclusion</title><p>The compositional characteristics of carotid atherosclerotic plaques, particularly IPH, were associated with perioperative CBF in patients with unilateral moderate-to-severe carotid stenosis undergoing CEA. Our findings indicated that the patients with larger carotid IPH could expect smaller improvement in CBF following CEA.</p></sec>