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Brain diffusion changes in carotid occlusive disease treated with endarterectomy

From the Departments of Neurology (Drs. Soinne, Helenius, Lindsberg, Kaste, and Tatlisumak), Thoracic and Cardiovascular Surgery (Dr. Saimanen), and Radiology (Dr. Salonen), Helsinki University Central Hospital, Finland; Neuroscience Program (Drs. Soinne, Lindsberg, and Tatlisumak), Biomedicum Helsinki, Helsinki, Finland.

Address correspondence and reprint requests to Dr. T. Tatlisumak, Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland; e-mail: turgut.tatlisumak{at}hus.fi

Background: Patients with unilateral high-grade carotid stenosis or occlusion have been reported to have more leukoaraiosis and ischemic lesions in ipsilateral than in contralateral cerebral hemisphere. The lesions alter apparent diffusion coefficient (ADC) values in diffusion-weighted MRI (DWI). The overall effects of carotid endarterectomy on ADC values have not yet been explored.

Objectives: To find out whether 1) average ADC (ADC_av) values differed between hemispheres, 2) diffusion changes induced by carotid endarterectomy could be detected in brain tissue with serial DWI, and 3) patients with asymptomatic carotid stenosis differed from patients with a symptomatic stenosis.

Methods: Forty-five patients (22 with asymptomatic carotid stenosis and 23 with symptomatic carotid stenosis) with unilateral high-grade carotid stenosis underwent DWI before carotid endarterectomy and 3 and 100 days afterward, and 45 age- and sex-matched healthy control subjects were imaged once. We evaluated ADC_av values in normal-appearing gray and white matter, watershed regions (WsR), and thalamus.

Results: ADC_av values of ipsilateral white matter and WsR were higher than those of contralateral white matter and WsR, both being higher than in white matter and WsR of control subjects. After carotid endarterectomy, these differences were diminished, but the levels remained higher than in controls. ADC_av values of gray matter and thalamus remained unaffected. Asymptomatic carotid stenosis and symptomatic carotid stenosis patient groups did not differ from each other.

Conclusions: Carotid stenosis has an effect on diffusion in the white matter of the ipsilateral hemisphere, and it is partly reversible by carotid endarterectomy. The finding may be associated with leukoaraiotic development ("preleukoaraiosis").

Received April 2, 2003. Accepted in final form June 23, 2003.

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