Multidetector computed tomography in the assessment of neurologic complications after carotid endarterectomy

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Abstract

Rationale: Carotid endarterectomy is a surgical procedure to prevent acute ischemic cerebrovascular accidents. Neurologic complications can occur after surgery. Multidetector computed tomography (MDCT) is used for their diagnosis in severely ill patients.

Aim: To evaluate the potential of MDCT in the diagnosis of neurologic complications after carotid endarterectomy.

Materials and methods: We analyzed the results of radiologic assessments in 15 patients with early postoperative neurologic complications which occurred after surgery for internal carotid artery occlusion (595 patients underwent surgery). In stable patients, brain magnetic resonance imaging (MRI) was performed (T1, T2, FLAIR, DWI modes) with non-contrast MR angiography. In critically ill patients, brain computed tomography, computed tomographic angiography and perfusion computed tomography were performed.

Results: Ischemic neurologic complications were found in 11 patients. One patient had no clinical manifestation of an ischemic stroke, and acute stage signs were found in his routine brain MDCT. In 9 patients with acute brain ischemia, MDCT (n = 6) and MRI (n = 3) results were specific for this diagnosis, with no diagnostic problems. There were problems with the diagnosis of the hyperacute ischemia in 1 patient. In this patient, the complication occurred against a background of abnormal carotid blood flow before surgery, therefore, differential diagnosis between the hyperperfusion syndrome on the intervention side and the hyperacute phase of ischemic insult on the opposite side was performed. Hyperperfusion syndrome and hemorrhagic strokes were observed in 4 patients.

Conclusion: The most difficult for diagnosis by MDCT is the hyperacute phase of brain ischemia. Further studies are necessary in the area of diagnosis of postoperative complications, with the search for potential specific diagnostic criteria.

About the authors

M. V. Vishnyakova Jr.

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: cherridra@mail.ru

MD, PhD, Senior Research Fellow, Department of Roentgenology

61/2–15 Shchepkina ul., Moscow, 129110, Russian Federation. Tel.: +7 (495) 631 72 07

Россия

R. N. Lar'kov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, PhD, Head of Department of Vascular and Ischemic Heart Disease Surgery

61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Россия

M. V. Vishnyakova

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

MD, PhD, Head of Department of Roentgenology

61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Россия

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Copyright (c) 2017 Vishnyakova Jr. M.V., Lar'kov R.N., Vishnyakova M.V.

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