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MRI Detection of Carotid Intraplaque Hemorrhage and Postintervention Cognition
S Culleton1, H Baradaran2, S-E Kim2
1From the Department of Radiology (S.C., H.B., S.-E.K., J.R., D.P., J.S.M.) Sinead.culleton@gmail.com.
Insights
Cognitive improvement after carotid revascularization is linked to plaque characteristics. Patients without intraplaque hemorrhage showed significant cognitive gains, while those with it did not.
Area of Science:
- Neuroscience
- Vascular Surgery
- Radiology
Background:
- Carotid revascularization is associated with cognitive improvements, often attributed to improved cerebral blood flow.
- The role of specific plaque characteristics, such as intraplaque hemorrhage, in modulating post-intervention cognitive outcomes remains unclear.
Purpose of the Study:
- To investigate the impact of carotid intraplaque hemorrhage on cognitive function following carotid revascularization procedures.
- To determine if the presence or absence of intraplaque hemorrhage influences cognitive changes after surgery.
Main Methods:
- A single-center study involving 23 patients undergoing carotid surgery (endarterectomy or angioplasty/stent placement).
- Preoperative carotid MRI (MPRAGE) was used to detect intraplaque hemorrhage.
- Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) before and after intervention.
- Statistical analysis included t-tests and multivariable linear regression to compare pre- and postintervention scores and group differences.
Main Results:
- Overall, patients showed significant improvements in Total Scale, immediate memory, and verbal index scores post-intervention.
- Participants with intraplaque hemorrhage (n=11) exhibited no significant cognitive improvement; attention index decreased (P=.045).
- Participants without intraplaque hemorrhage (n=12) demonstrated significant improvements in Total Scale (P=.004), immediate memory (P=.002), delayed memory (P=.03), and verbal index (P=.009).
- Significant differences in cognitive outcome changes were observed between the intraplaque hemorrhage positive and negative groups.
Conclusions:
- Cognitive enhancement after carotid intervention is primarily associated with plaques lacking intraplaque hemorrhage.
- Preoperative detection of intraplaque hemorrhage using MRI may serve as a crucial predictor of cognitive response to carotid revascularization.
Background And Purpose:
Cognitive improvement has been reported after carotid revascularization and attributed to treating stenosis and correcting hypoperfusion. This study investigated the effect of carotid intraplaque hemorrhage on postintervention cognition.
Materials And Methods:
In this institutional review board-approved single-center study, consecutive patients scheduled for carotid surgery were recruited for preoperative carotid MR imaging (MPRAGE) and pre- and postintervention cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status. Pre- and postintervention scores were compared using t tests and multivariable linear regression.
Results:
Twenty-three participants were included, with endarterectomy performed in 20 (87%) and angioplasty/stent placement, in 3 (13%). Overall, statistically significant improvements occurred in the pre- versus postintervention mean Total Scale score (92.1 [SD, 15.5] versus 96.1 [SD, 15.8], P = .04), immediate memory index (89.4 [SD, 18.2] versus 97.7 [SD, 14.9], P < .001), and verbal index (96.1 [SD, 14.1] versus 103.0 [SD, 12.0], P = .002). Intraplaque hemorrhage (+) participants (n = 11) had no significant improvement in any category, and the attention index significantly decreased (99.4 [SD, 18.0] versus 93.5 [SD, 19.4], P = .045). Intraplaque hemorrhage (-) participants (n = 12) significantly improved in the Total Scale score (86.4 [SD, 11.8] versus 95.5 [SD, 12.4], P = .004), immediate memory index (82.3 [SD, 14.6] versus 96.2 [SD, 14.1], P = .002), delayed memory index (94.3 [SD, 14.9] versus 102.4 [SD, 8.0], P = .03), and verbal index (94.3 [SD, 13.2] versus 101.5 [SD, 107.4], P = .009). Postintervention minus preintervention scores for intraplaque hemorrhage (+) versus (-) groups showed statistically significant differences in the Total Scale score (-0.4 [SD, 6.8] versus 8.0 [SD, 8.5], P = .02), attention index (-5.9 [SD, 8.5] versus 4.3 [SD, 11.9], P = .03), and immediate memory index (4.2 [SD, 6.7] versus 12.2 [SD, 10.2], P = .04).
Conclusions:
Cognitive improvement was observed after carotid intervention, and this was attributable to intraplaque hemorrhage (-) plaque. MR imaging detection of intraplaque hemorrhage status may be an important determinant of cognitive change after intervention.
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