Abstract Details

Title Treatment Strategy Based on Carotid Plaque Vulnerability Identified by Simultaneous Non-contrast Angiography and IntraPlaque Hemorrhage (SNAP) Imaging

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-005

Objective This study was to apply Simultaneous Non-contrast Angiography and intraPlaque hemorrhage (SNAP) imaging to preoperative risk stratification and surgical planning of carotid stenosis.

Background The safety of carotid artery stenting (CAS) in patients with intraplaque hemorrhage (IPH) was still controversial considering perioperative ischemic complications. SNAP imaging simultaneously generated vessel wall imaging to identify vulnerable plaques especially IPH, and angiography for feasible stenosis measurement.

Design/Methods The study prospectively recruited 25 subjects (63.2±8.4 years, 15 males) diagnosed with carotid stenosis (≥50%) by ultrasound between February 28 and July 20, 2019. Preprocedural non-contrast carotid MR imaging was performed on a whole-body 3.0-T MR scanner. The T1W, T2W, 3D TOF and SNAP imaging were acquired axially centered at the bifurcation of carotid arteries. IPH and calcification on SNAP imaging were defined as hyperintense compared to adjacent muscle and hypointense on processed proton density (PD)-weighted image respectively. Area stenotic rates measured on SNAP imaging were compared to those automatedly generated from digital subtract angiography (DSA). The primary outcome composited any stroke and death within 30 days postoperatively.

Results Of the 50 carotid arteries, 28.0% IPH and 70.0% calcifications were identified on SNAP images. Stenosis measurement on SNAP and DSA revealed a high agreement with an intra-class correlation coefficient of 0.87 (0.81, 0.94) for quantitative stenosis rates and a weighted kappa of 0.92 (0.88, 0.96) for stenosis grading. 21 subjects underwent CAS using emboli protection devices and self-expanding close-cell stents. Two patients underwent carotid endarterectomy (CEA) because of severe calcification, while two with asymptomatic moderate carotid stenosis and stable plaque were prescribed with aspirin and statins after DSA. Primary outcomes occurred in neither surgical candidates nor patients simply on medication.

Conclusions Noninvasive SNAP imaging might be a rational tool for preoperative assessment. The study provided cumulative evidence for the safety of protected CAS in patients with carotid stenosis and IPH.

Authors/Disclosures
Yi Shen, MD (Cedars-Sinai Medical Center) PRESENTER	Dr. Shen has nothing to disclose.
Jian Wu, PhD (Beijing Tsinghua Changgung Hospital)	Dr. Wu has nothing to disclose.

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Abstract Details