IMAGING ALGORITHMS FOR OCCLUSIVE CAROTID DISEASE IN TREATMENT STRATEGY
https://doi.org/10.20862/0042-4676-2017-98-5-231-237
Abstract
Objective – to optimize imaging algorithms of preoperative evaluation and postoperative changes and complications in patients with occlusive carotid disease.
Material and methods. Results of pre- and postoperative imaging of patients with occlusive carotid disease during 2012–2016 years were analyzed. Four groups were defined: assessment of CT-angiography (CTA) for preoperative planning (256 patients); the role of CTA for postoperative changes (51 patients); CT-perfusion (CTP) abilities in cerebral circulation assessment before and after surgery (103 and 76 patients); CT and MRI in diagnosis of postoperative neurologic complications (595 patients).
Results. CTA employment in preoperative examination increased accuracy of occlusive process evaluation and changed management strategy in 6 patients. With CTA data we were able to define three variants of postoperative carotid changes: “expected” condition; changes that require further dynamic control studies; complications. The most reasonable was CTP employment for patients with combination of stenosis of one carotid artery and occlusion of contralateral artery. For diagnosis of neurologic complication first line examination was MRI, than for further assessment – CTA and CTP.
Conclusion. Complex imaging algorithm for occlusive carotid disease assessment, defining of postoperative vascular status and possible neurologic complications provide necessary information for management strategy examination.
About the Author
M. V. Vishnyakova
M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, ul. Shchepkina
Russian Federation
Russian Federation
Jr., MD, PhD, Senior Researcher; 61/2, Moscow, 129110, Russian Federation
References
1. Stakhovskaya L.V., Kotov S.V. (eds). Stroke: Guide for doctors. Moscow: Meditsinskoe Informatsionnoe Agentstvo; 2013 (in Russ.).
2. National guidelines for managing patients with brachiocephalic artery disease. Moscow; 2013 (in Russ.).
3. Vereshchagin N.V. The role of lesions of extracranial divisions of the main divisions of the head in the pathogenesis of cerebral circulation disorders. Cardiovascular diseases of the nervous system. Smolensk; 1980: 23–6 (in Russ.).
4. Ricotta J.J., Aburahma A., Ascher E., Eskandari M., Faries P., Lal B.K. et al. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J. Vasc. Surg. 2011; 54 (3): 1–31.
5. Mamedov F.R., Arutyunov N.V., Usachev D.Yu., Mel’nikova-Pitskhelauri T.V., Pyashina D.V., Fadeeva L.M., Kornienko V.N. Complex neuroradiology assessment of atherosclerotic carotid disease. Vestnik Rentgenologii i Radiologii (Russian Journal of Radiology). 2011; 1: 4–10 (in Russ.).
6. Mamedov F.R., Arutyunov N.V., Usachev D.Yu., Lukshin V.A., Mel’nikova-Pitskhelauri T.V., Fadeeva L.M. et al. Contemporary neuroimaging methods for stenosis and occlusions of carotid arteries. Luchevaya Diagnostika i Terapiya (Radiologic Diagnostics and Treatment, Russian journal). 2012; 3 (3): 109–16 (in Russ.).
7. Vishnyakova M.V. (Jr.), Pronin I.N., Lar’kov R.N., Vishnyakova M.V. Detailed assessment the occlusive carotid disease with computed angiography for the reconstructive surgery planning. Vestnik Rentgenologii i Radiologii (Russian Journal of Radiology). 2017; 98 (2): 69–77 (in Russ.).
8. Jauch E.C. et al. Guidelines for the early management of patient with acute ischemic stroke. Stroke. 2013; 44: 870–947.
9. Gladstone D.J., Kapral M.K., Fang J., Laupacis A., Tu J.V. Management and outcomes of transient ischemic attacks in Ontario. CMAJ. 2004; 170: 1099–104.
10. Ashok Srinivasan, Mayank Goyal, Faisal Al Azri, Cheemun Lum. State of the art imaging of acute stroke. RadioGraphics. 2006; 26: S75–S95.
11. Van Seeters T., Biessels G.J., Kappelle L.J., Van der Schaaf I.C., Dankbaar J.W. et al. The prognostic value of CT angiography and CT perfusion in acute ischemic stroke. Cerebrovasc. Dis. 2015; 40 (5–6): 258–69.
12. Ye Xin, Fu-Gang Han. Diagnostic accuracy of computed tomography perfusion in patients with acute stroke: a meta-analysis. J. Neurolog. Sci. 2016; 360: 125–30.
13. Nemirovskaya T.A., Nemirovskiy A.M., Danilov V.I., Mikhaylov M.K., Ibatullin M.M., Alekseev A.G. Estimation of the influence of stenoses and occlusions of the internal carotid artery on cerebral hemodynamics with perfusion X-ray computed tomography. Kazanskiy Meditsinskiy Zhurnal (Kazan Medical Journal, Russian journal). 2011; 92 (3) (in Russ.).
14. Fukuda T., Ogasawara K., Kobayashi M., Komoribayashia N., Endoa H., Inouea T. et al. Prediction of cerebral hyperperfusion after carotid endarterectomy using cerebral blood volume measured by perfusionweighted MR imaging compared with single-photon emission CT. AJNR. 2007; 28: 737–42.
15. Vishnyakova M.V. (Jr.), Lar’kov R.N., Vishnyakova M.V. Diagnosis of neurological complications after carotid endarterectomy with multispiral computed tomography. Al’manakh Klinicheskoy Meditsiny (Almanac of Clinical Medicine, Russian journal). 2017; 45 (3): 218–24 (in Russ.).
16. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N. Engl. J. Med. 1991; 325: 445–53.
17. 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.
Review
For citations:
Vishnyakova M.V. IMAGING ALGORITHMS FOR OCCLUSIVE CAROTID DISEASE IN TREATMENT STRATEGY. Journal of radiology and nuclear medicine. 2017;98(5):231-237. (In Russ.) https://doi.org/10.20862/0042-4676-2017-98-5-231-237
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