Abstract 2327: Impact Of MRI Based Carotid Artery Plaque Evaluation On The Risks Of Thromboembolic Events During Carotid Artery Stenting

Objective: To evaluate if the MRI image findings of carotid arterial plaques using Magnetization-Prepared Rapid Acquisition with Gradient Echo (MPRAGE) is associated with the risk of thromboembolic event during carotid artery stenting (CAS). Methods: A total of 109 carotid stenting was performed on 99 patients. Correlation between the Pre-operative MRI findings of carotid arterial plaque using MPRAGE and the procedure related thromboembolic event was assessed. Distal protection devices were used in all cases including a balloon protection device (Guardwire) and filter devices (AngioguardXP, Filterwire EZ). All lesions were classified into three types according to the intensities on MPRAGE: high intensity (group A), intermediate intensity (group B) and iso-intensity groups (group B). Procedure related morbidity within 30days of procedure was evaluated using Modified Rankin Scale (MRS). Results: Neurological ischemic events associated with the carotid stenting occurred in 11 out of 109 procedures (10.1%). Two (1.8%) cases showed persistent neurological deficit and six (5.5%) showed transient neurological events. Ocular ischemia occurred in 3 cases (2.8%). Thromboembolic events in group A (n=40), group B (n=36) and group C (n=30) were 7 (23.3%), 4 (11.1%) and 0 (0%), respectively. The incidence of thromboembolic events was significantly higher in the combined group A and B as compared to that in group C (P=0.006). Thromboembolic events of CAS with use of Guardwire, Angioguard and Filterwire were 12.1%, 14.3% and 0%, respectively. In CAS for high intensity plaque (n=66), incidence of thromboembolic event with use of Angioguard (4 of 15, 26.7%) was higher than that of Guardwire (7 of 38, 18.4%). In group A, none of the cases (n=20) treated with filter wire showed procedure related ischemic event. Conclusions: High intensity plaque on MPRAGE can be related to high rate of thromboembolic events during CAS.