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Research ArticleAdult Brain

Absence of the Anterior Communicating Artery on Selective MRA is Associated with New Ischemic Lesions on MRI after Carotid Revascularization

S. Yamashita, M. Kohta, K. Hosoda, J. Tanaka, K. Matsuo, H. Kimura, K. Tanaka, A. Fujita and T. Sasayama
American Journal of Neuroradiology July 2022, DOI: https://doi.org/10.3174/ajnr.A7570
S. Yamashita
aFrom the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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M. Kohta
aFrom the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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K. Hosoda
bDepartment of Neurosurgery (K.H.), Kobe City Nishi-Kobe Medical Center, Kobe, Japan
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J. Tanaka
aFrom the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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K. Matsuo
aFrom the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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H. Kimura
aFrom the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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K. Tanaka
aFrom the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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A. Fujita
aFrom the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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T. Sasayama
aFrom the Department of Neurosurgery (S.Y., M.K., J.T., K.M., H.K., K.T., A.F., T.S.), Kobe University Graduate School of Medicine, Kobe, Japan
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  • FIG 1.
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    FIG 1.

    A, The BeamSAT pulse is positioned to cover the unilateral petrous portion of the ICA and bilateral vertebral arteries in an axial TOF source image obtained with conventional MRA (A). By adding the BeamSAT pulse to the unilateral ICA and bilateral vertebral arteries on 3D TOF-MRA (B), we performed ICA-selective MRA (C). The asterisk indicates BeamSAT.

  • FIG 2.
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    FIG 2.

    A, A case with an AcomA. The bilateral anterior cerebral arteries are perfused from the ICA of the nonstenotic side. Only the ipsilateral anterior cerebral artery is perfused by the ICA of the stenotic side. B, A case without an AcomA. Each ICA perfuses only the ipsilateral anterior cerebral artery. White arrows show the direction of blood flow. Bil. indicates bilateral; Rt., right; Lt., left.

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    FIG 3.

    A, Box-and-whisker plots of preoperative CBF on the stenotic side in the AcomA (+) group and the AcomA (−) group. Preoperative CBF is not significantly different between the 2 groups. B, Box-and-whisker plots of preoperative CVR on the stenotic side in the AcomA (+) group and the AcomA (−) group. The CVR to the acetazolamide challenge is not significantly different between the 2 groups. The thick horizontal lines divide the boxes at the median values. The bottom and top of the boxes indicate the first and third quartiles. The whiskers extend to the most extreme data points, which are no more than 1.5 times the interquartile range from the box.

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    FIG 4.

    A, Box-and-whisker plots of preoperative CBF on the stenotic side in the AcomA (+)/PSV ≥200 cm/s group and the AcomA (−) / PSV ≥200 cm/s group. Preoperative CBF is not significantly different between the 2 groups. B, Box-and-whisker plots of preoperative CVR on the stenotic side in the AcomA (+) / PSV ≥200 cm/s group and the AcomA (−) / PSV ≥200 cm/s group. The CVR to the acetazolamide challenge is significantly lower in the AcomA (−) / PSV ≥200 cm/s group than in the AcomA (+) / PSV ≥200 cm/s group. The thick horizontal lines divide the boxes at the median values. The bottom and top of the boxes indicate the first and third quartiles. The whiskers extend to the most extreme data points, which are no more than 1.5 times the interquartile range from the box. The asterisk indicates P < . 05.

  • FIG 5.
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    FIG 5.

    Box-and-whisker plots of the decrease in rSO2 after temporary ICA occlusion on the stenotic side during CEA or CAS. The decrease in rSO2 is significantly greater in the AcomA (−) group than in the AcomA (+) group. The thick horizontal lines divide the boxes at the median values. The bottom and top of the boxes indicate the first and third quartiles. The whiskers extend to the most extreme data points, which are no more than 1.5 times the interquartile range from the box. Double asterisks indicate P < . 01.

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    Table 1:

    Patients’ baseline characteristicsa

    AcomA (+) (n = 61)AcomA (–) (n = 22)P Value
    Age (yr)75.1 (SD, 7.4)76.9 (SD, 5.9).24
    Male53 (87%)19 (86%)1
    Rt. ICS30 (49%)8 (36%).33
    CAS26 (43%)6 (27%).31
    Symptomatic24 (39%)12 (55%).32
    Degree of stenosis (%)74.7 (SD, 12.7)76.0 (SD, 10.4).77
    PSV (cm/s)281.1 (SD, 120.5)250.8 (SD, 138.5).37
    Hypertension45 (74%)19 (86%).37
    Hyperlipidemia33 (54%)16 (73%).14
    Diabetes mellitus21 (34%)7 (32%)1
    Ischemic heart disease11 (18%)2 (9%).50
    Smoking31 (51%)13 (59%).62
    COPD6 (10%)2 (9%)1
    Postoperative DWI high12 (20%)11 (50%).011
    • Note:—Rt indicates right; ICS, ICA stenosis; COPD, chronic obstructive pulmonary disease.

    • ↵a Values are presented as mean (SD) or number (%).

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    Table 2:

    Univariate and multivariate logistic regression analyses of factors for new ischemic lesions on MR imaginga

    PredictorUnivariate AnalysisMultivariate Analysis
    DWI-Positive (n = 23)DWI-Negative (n = 57)P ValueOR (95% CI)P Value
    Presence of AcomA12 (52%)46 (81%).0140.07 (0.012–0.45).005
    Age (mean)78.0 (SD, 5.7)74.4 (SD, 7.3).0231.14 (1.01–1.29).039
    CAS15 (65%)17 (30%).00512.99 (2.01–80.86).006
    Preoperative CVR (mean) (%)43.4 (SD, 25.9)37.8 (SD, 24.1).401.02 (0.99–1.05).20
    Ulcerated plaque7 (30%)15 (26%).783.07 (0.60–15.76).18
    • ↵a ORs of age and CVR are presented as estimated odds of outcome for a 1 year increase in age and a 1% increase in percentage.

    • View popup
    Table 3:

    Univariate and multivariate logistic regression analyses of factors for new ischemic lesions on MR imaging in patients with a PSV of ≥200 cm/sa

    PredictorUnivariate AnalysisMultivariate Analysis
    DWI-Positive (n = 13)DWI-Negative (n = 39)P ValueOR (95% CI)P Value
    Presence of AcomA6 (46%)34 (87%).0050.08 (0.011–0.64).017
    Age (mean)78.7 (SD, 4.3)75.0 (SD, 7.4).0321.13 (0.96–1.32).13
    CAS7 (54%)14 (36%).334.23 (0.62–28.89).14
    Preoperative CVR (mean) (%)35.7 (SD, 18.7)36.7 (SD, 24.5).881.02 (0.98–1.06).34
    Ulcerated plaque5 (38%)8 (21%).274.71(0.77–28.83).094
    • ↵a ORs of age and CVR are presented as estimated odds of outcome for a 1 year increase in age and a 1% increase in percentage.

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S. Yamashita, M. Kohta, K. Hosoda, J. Tanaka, K. Matsuo, H. Kimura, K. Tanaka, A. Fujita, T. Sasayama
Absence of the Anterior Communicating Artery on Selective MRA is Associated with New Ischemic Lesions on MRI after Carotid Revascularization
American Journal of Neuroradiology Jul 2022, DOI: 10.3174/ajnr.A7570

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Absence of the Anterior Communicating Artery on Selective MRA is Associated with New Ischemic Lesions on MRI after Carotid Revascularization
S. Yamashita, M. Kohta, K. Hosoda, J. Tanaka, K. Matsuo, H. Kimura, K. Tanaka, A. Fujita, T. Sasayama
American Journal of Neuroradiology Jul 2022, DOI: 10.3174/ajnr.A7570
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