Ex vivo differential phase contrast and magnetic resonance imaging for characterization of human carotid atherosclerotic plaques

Abstract Non-invasive detection of specific atherosclerotic plaque components related to vulnerability is of high clinical relevance to prevent cerebrovascular events. The feasibility of magnetic resonance imaging (MRI) for characterization of plaque components was already demonstrated. We aimed to evaluate the potential of ex vivo differential phase contrast X-ray tomography (DPC) to accurately characterize human carotid plaque components in comparison to high field multicontrast MRI and histopathology. Two human plaque segments, obtained from carotid endarterectomy, classified according to criteria of the American Heart Association as stable and unstable plaque, were examined by ex vivo DPC tomography and multicontrast MRI (T1-, T2-, and proton density-weighted imaging, magnetization transfer contrast, diffusion-weighted imaging). To identify specific plaque components, the plaques were subsequently sectioned and stained for fibrous and cellular components, smooth muscle cells, hemosiderin, and fibrin. Histological data were then matched with DPC and MR images to define signal criteria for atherosclerotic plaque components. Characteristic structures, such as the lipid and necrotic core covered by a fibrous cap, calcification and hemosiderin deposits were delineated by histology and found with excellent sensitivity, resolution and accuracy in both imaging modalities. DPC tomography was superior to MRI regarding resolution and soft tissue contrast. Ex vivo DPC tomog...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research

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Conclusion: There were no complications resulting from partial sternotomy in the two cases presented. CEA with partial sternotomy could be an effective treatment option for CCAO in which the internal carotid artery is patent and thrombus extends to the proximal CCA. PMID: 31966920 [PubMed]
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
Intraplaque haemorrhage (IPH) has been independently associated with a higher risk of future ipsilateral stroke in patients with carotid artery stenosis. Evaluation of plaque characteristics may contribute to risk assessment of recurrent (silent) cerebrovascular events in order to prioritise patients for timing of treatment. It is unknown if patients showing histologically apparent IPH also have increased risk of silent ischaemic brain lesions in the waiting period between index event and revascularisation.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
Introduction: Carotid endarterectomy is an established surgical intervention that is associatedwith a reduction in the future risk of stroke in symptomatic patients. However, the identification of culprit carotid plaque remains challenging for number of reasons including the suboptimal evaluation of carotid plaque morphology, disease activity and future stroke risk stratification.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Introduction: Endarterectomy remains the gold standard in carotid artery revascularization because carotid artery stenting entails more embolization. But the Roadster trial with the transcervical approach showed excellent results, similar to CEA stroke rates. The new generation stent is supposed to reduce plaque prolapse and postoperative embolization. The use of this stent in combination with the transcervical approach could improve the Roadster results.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Introduction: Post-operative white-matter brain lesions on diffusion-weighted magnetic resonance imaging (DWI-MRI) after carotid endarterectomy (CEA) are associated with an unfavourable neurological outcome. Up to 17% of patients undergoing CEA show new post-intervention DWI lesions. These lesions are regarded as a sign of acute ischemia and thought to be caused by both perioperative hemodynamic changes and, more importantly, by arterial micro-emboli. The main components of the micro-embolic signals (MES) that are detected with transcranial Doppler imaging (TCD) are platelet aggregates.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Intraplaque haemorrhage (IPH) has been independently associated with a higher risk of future ipsilateral stroke in patients with carotid artery stenosis. Evaluation of plaque characteristics may contribute to risk assessment of recurrent (silent) cerebrovascular events in order to prioritise patients for timing of treatment. It is unknown if patients showing histologically apparent IPH also have increased risk of silent ischaemic brain lesions in the waiting period between index event and revascularisation.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
CONCLUSION: Symptomatic patients with ipsilateral carotid stenosis and silent brain ischaemia on pre-operative MR-DWI, more often showed pathological evidence of IPH compared with those without ischaemic lesions. This identifies carotid IPH as a marker for patients at risk of silent brain ischaemia and possibly for future stroke and other arterial disease complications. Such patients may be more likely to benefit from CEA than those without evidence of ipsilateral carotid IPH. PMID: 31631008 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research
While the perioperative stroke rate after carotid endarterectomy (CEA) is low, “silent” microinfarctions identified by magnetic resonance imaging (MRI) are common and have been correlated with postoperative neurocognitive decline. Our study will investigate the role of remote ischemic preconditioning (RIPC) as a potential neuroprotective mechanism. RIPC is a well-tolerated stimulus that, through neuronal and humoral pathways, generates a systemic environment of greater resistance to subsequent ischemic insults.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research Source Type: research
While the perioperative stroke rate after carotid endarterectomy (CEA) is low, magnetic resonance imaging (MRI) “silent” microinfarctions are common and have been correlated with postoperative neurocognitive decline. Our study will investigate the role of remote ischemic preconditioning (RIPC) as a potential neuroprotective mechanism. RIPC is a well-tolerated stimulus that, through neuronal and humoral pa thways, generates a systemic environment of greater resistance to subsequent ischemic insults.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
Ahmed Mohamed Elhfnawy1*, Peter U. Heuschmann2, Mirko Pham3†, Jens Volkmann1† and Felix Fluri1,4 1Department of Neurology, University Hospital Würzburg, Würzburg, Germany 2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany 3Institute of Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany 4Department of Neurology, Kantonssptial St. Gallen, St. Gallen, Switzerland Background and Purpose: Internal carotid artery stenosis (ICAS)≥70% is a leading cause of ischemic cerebrovascular event...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
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