The Correlation Research Between Carotid Plaque Characteristics And Perioperative Cerebral Blood Flow In Patients Undergoing Carotid Endarterectomy For Moderate To Severe Carotid Artery Stenosis

Objective:To unfold the relationship between carotid plaque characteristics and perioperative cerebral blood flow(CBF)by high-resolution vessel wall imaging(HR-VWI)as well as three-dimensional arterial spin labeling(3D-ASL)imaging.Methods: Patients with moderate to severe unilateral carotid artery stenosis proposed for carotid endarterectomy(CEA)were selected and underwent perioperative carotid HR-VWI and cranial 3D-ASL imaging to measure the following imaging features: relative cerebral blood flow(r CBF)in the middle cerebral artery region(r CBF = cerebral blood flow in the affected cerebral hemisphere/cerebral blood flow in the contralateral cerebral hemisphere),vascular characteristics,intraplaque lipid-rich necrotic foci(LRNC),intraplaque hemorrhage(IPH),calcification;plaque area and percentage of the maximum area of plaque components.The relationship between plaque component characteristics and perioperative cerebral blood flow(CBF)was analyzed.Results: A total of 28 cases were included in the study,(mean age 64.4±7.9 years,23 males and 5 females).Among morphological features,carotid stenosis rate was significantly negatively correlated with preoperative r CBF(β,-0.528;95%CI,-0.010 to-0.002;P=0.004).After adjusting for confounding factors,there was no significant correlation between carotid stenosis rate and preoperative r CBF of CEA(β,0.024;95%CI,-0.116 to 0.127;P=0.926).Univariate linear regression analysis showed that the percentage of maximum IPH area was significantly negatively correlated with preoperative r CBF(β,-0.441;95%CI,-0.008 to-0.001;P=0.021).IPH area was negatively correlated with r CBF after CEA(β,-0.486;95%CI,-0.012-0.002;P=0.010).After adjusting for confounding factors,multiple linear regression analysis showed that there was no significant correlation between the percentage of maximum IPH area and preoperative r CBF(β,-0.156;95%CI,-0.150 to 0.082;P=0.550).The area correlation of IPH remained statistically significant(β,-0.696;95%CI,-0.016 to-0.004;P=0.001).Conclusion:Among the component characteristics of carotid plaques,especially IPH was closely associated with changes in perioperative cerebral blood flow in patients with unilateral moderate to severe carotid stenosis treated with CEA.The findings suggest that patients with greater carotid IPH had less improvement in cerebral blood flow after CEA.