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<meta name="DC.Title" content="Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging" />
<meta name="DC.Date" content="2001-04-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Intraprocedural transcranial Doppler sonography has identified multiple microembolic events during and immediately after carotid endarterectomy (CEA) or angioplasty, yet the rate of clinically evident stroke is small. To determine the significance of the transcranial Doppler sonography findings, we examined patients by use of diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging before and immediately after CEA for evidence of clinically silent ischemic events.

METHODS: Twenty-five patients with atherosclerotic disease of the carotid arteries underwent diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging performed, on average, 3 days before and 12 hours after CEA. Diffusion-weighted images were acquired in three orthogonal directions at b = 900. Pre- and postoperative neurologic examinations were performed by the same physician.

RESULTS: After endarterectomy, 4.0% of the patients (one of 25 patients) showed a single, cortical focus of restricted diffusion and new fluid-attenuated inversion recovery hyperintensity, measuring &lt;1 cm in diameter, ipsilateral to the CEA. The postoperative neurologic examination showed no change in status from the preoperative baseline state. This patient had an intraoperative course complicated by the development of a large luminal thrombus, necessitating thrombectomy.

CONCLUSION: The use of diffusion-weighted imaging may serve to improve conspicuity of clinically silent infarcts after CEA. An important next step is to determine the risk factors that predispose to detectable parenchymal ischemic events." />
<meta name="DC.Contributor" content="Robert J. Feiwell" />
<meta name="DC.Contributor" content="Lavrentios Besmertis" />
<meta name="DC.Contributor" content="Rajabrata Sarkar" />
<meta name="DC.Contributor" content="David A. Saloner" />
<meta name="DC.Contributor" content="Joseph H. Rapp" />
<meta name="article:published_time" content="2001-04-01" />
<meta name="article:section" content="BRAIN" />
<meta name="citation_title" content="Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;i&gt;BACKGROUND AND PURPOSE:&lt;/i&gt; Intraprocedural transcranial Doppler sonography has identified multiple microembolic events during and immediately after carotid endarterectomy (CEA) or angioplasty, yet the rate of clinically evident stroke is small. To determine the significance of the transcranial Doppler sonography findings, we examined patients by use of diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging before and immediately after CEA for evidence of clinically silent ischemic events.&lt;/p&gt;&lt;p&gt;&lt;i&gt;METHODS:&lt;/i&gt; Twenty-five patients with atherosclerotic disease of the carotid arteries underwent diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging performed, on average, 3 days before and 12 hours after CEA. Diffusion-weighted images were acquired in three orthogonal directions at b = 900. Pre- and postoperative neurologic examinations were performed by the same physician.&lt;/p&gt;&lt;p&gt;&lt;i&gt;RESULTS:&lt;/i&gt; After endarterectomy, 4.0% of the patients (one of 25 patients) showed a single, cortical focus of restricted diffusion and new fluid-attenuated inversion recovery hyperintensity, measuring &amp;lt;1 cm in diameter, ipsilateral to the CEA. The postoperative neurologic examination showed no change in status from the preoperative baseline state. This patient had an intraoperative course complicated by the development of a large luminal thrombus, necessitating thrombectomy.&lt;/p&gt;&lt;p&gt;&lt;i&gt;CONCLUSION:&lt;/i&gt; The use of diffusion-weighted imaging may serve to improve conspicuity of clinically silent infarcts after CEA. An important next step is to determine the risk factors that predispose to detectable parenchymal ischemic events.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="Robert J. Feiwell" />
<meta name="citation_author" content="Lavrentios Besmertis" />
<meta name="citation_author" content="Rajabrata Sarkar" />
<meta name="citation_author" content="David A. Saloner" />
<meta name="citation_author" content="Joseph H. Rapp" />
<meta name="twitter:title" content="Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Intraprocedural transcranial Doppler sonography has identified multiple microembolic events during and immediately after carotid endarterectomy (CEA) or angioplasty, yet the rate of clinically evident stroke is small. To determine the significance of the transcranial Doppler sonography findings, we examined patients by use of diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging before and immediately after CEA for evidence of clinically silent ischemic events.

METHODS: Twenty-five patients with atherosclerotic disease of the carotid arteries underwent diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging performed, on average, 3 days before and 12 hours after CEA. Diffusion-weighted images were acquired in three orthogonal directions at b = 900. Pre- and postoperative neurologic examinations were performed by the same physician.

RESULTS: After endarterectomy, 4.0% of the patients (one of 25 patients) showed a single, cortical focus of restricted diffusion and new fluid-attenuated inversion recovery hyperintensity, measuring &lt;1 cm in diameter, ipsilateral to the CEA. The postoperative neurologic examination showed no change in status from the preoperative baseline state. This patient had an intraoperative course complicated by the development of a large luminal thrombus, necessitating thrombectomy.

CONCLUSION: The use of diffusion-weighted imaging may serve to improve conspicuity of clinically silent infarcts after CEA. An important next step is to determine the risk factors that predispose to detectable parenchymal ischemic events." />
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<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Intraprocedural transcranial Doppler sonography has identified multiple microembolic events during and immediately after carotid endarterectomy (CEA) or angioplasty, yet the rate of clinically evident stroke is small. To determine the significance of the transcranial Doppler sonography findings, we examined patients by use of diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging before and immediately after CEA for evidence of clinically silent ischemic events.

METHODS: Twenty-five patients with atherosclerotic disease of the carotid arteries underwent diffusion-weighted imaging and fluid-attenuated inversion recovery MR imaging performed, on average, 3 days before and 12 hours after CEA. Diffusion-weighted images were acquired in three orthogonal directions at b = 900. Pre- and postoperative neurologic examinations were performed by the same physician.

RESULTS: After endarterectomy, 4.0% of the patients (one of 25 patients) showed a single, cortical focus of restricted diffusion and new fluid-attenuated inversion recovery hyperintensity, measuring &lt;1 cm in diameter, ipsilateral to the CEA. The postoperative neurologic examination showed no change in status from the preoperative baseline state. This patient had an intraoperative course complicated by the development of a large luminal thrombus, necessitating thrombectomy.

CONCLUSION: The use of diffusion-weighted imaging may serve to improve conspicuity of clinically silent infarcts after CEA. An important next step is to determine the risk factors that predispose to detectable parenchymal ischemic events." />
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      <h1 class="highwire-cite-title" id="page-title">Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Robert J. Feiwell</span>, <span class="highwire-citation-author" data-delta="1">Lavrentios Besmertis</span>, <span class="highwire-citation-author" data-delta="2">Rajabrata Sarkar</span>, <span class="highwire-citation-author" data-delta="3">David A. Saloner</span> and <span class="highwire-citation-author" data-delta="4">Joseph H. Rapp</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2001,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">22 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">646-649; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-11318--6865227973" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Robert J. Feiwell </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Robert%2BJ.%2BFeiwell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Feiwell%20RJ&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARobert%2BJ.%2BFeiwell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Lavrentios Besmertis </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Lavrentios%2BBesmertis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Besmertis%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ALavrentios%2BBesmertis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Rajabrata Sarkar </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Rajabrata%2BSarkar%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sarkar%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARajabrata%2BSarkar%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">David A. Saloner </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=David%2BA.%2BSaloner%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Saloner%20DA&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADavid%2BA.%2BSaloner%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Joseph H. Rapp </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Joseph%2BH.%2BRapp%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rapp%20JH&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJoseph%2BH.%2BRapp%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list"><li><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1 in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-22.4.646.1"><div class="cit-metadata"><cite> North American Symptomatic Carotid Endarterectomy Trial collaborators.  <strong>Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.</strong> <span class="cit-source">N Engl J Med</span> <span class="cit-pub-date">1991</span>;<span class="cit-vol">325</span>:<span class="cit-fpage">445</span>-453</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=1852179&amp;link_type=MED&amp;atom=%2Fajnr%2F22%2F4%2F646.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a 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<strong>Cerebral microembolism and ischemic changes associated with carotid endarterectomy.</strong> <span class="cit-source">J Vasc Surg</span> <span class="cit-pub-date">1998</span>;<span class="cit-vol">27</span>:<span class="cit-fpage">1024</span>-1031</cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1016/S0741-5214(98)70005-9&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=9652464&amp;link_type=MED&amp;atom=%2Fajnr%2F22%2F4%2F646.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=000074335200008&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7 in text" id="ref-7">↵</a><div class="cit ref-cit 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</span>Full Text</span></span></a></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8 in text" id="ref-8">↵</a><div class="cit ref-cit ref-other" id="cit-22.4.646.8"><div class="cit-metadata unstructured">Forbes KP, Shill HA, Britt PM, Zabramski JM, Spetzler RF, Heiserman JE.  <strong>Assessment of silent embolism from carotid endarterectomy using diffusion weighted imaging.</strong>  Presented at the 38th Annual Meeting of the American Society of Neuroradiology, Atlanta, April 3–8, 2000 </div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9 in text" id="ref-9">↵</a><div class="cit ref-cit ref-other" id="cit-22.4.646.9"><div class="cit-metadata"><cite>Barth A, Remonda L, Lovblad KO, Schroth G, Seiler RW.  <strong>Silent cerebral ischemia detected by diffusion-weighted MRI after carotid endarterectomy.</strong> <span class="cit-source">Stroke</span> <span 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cit-ref-sprinkles-medline"><span>PubMed</span></a><a href="/lookup/external-ref?access_num=A1990EB94000002&amp;link_type=ISI" class="cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience"><span>Web of Science</span></a></div></div></li><li><div class="cit ref-cit ref-other no-rev-xref" id="cit-22.4.646.11"><div class="cit-metadata"><cite>Williams PL, Warwick R, Dyson M, Bannister LH.  <strong><em>Gray's Anatomy.</em> 37th ed.</strong> <span class="cit-source">New York: Churchill-Livingston</span> <span class="cit-pub-date">1989</span>;<span class="cit-fpage">686</span></cite></div><div class="cit-extra"></div></div></li><li><a class="rev-xref-ref" href="#xref-ref-12-1" title="View reference 12 in text" id="ref-12">↵</a><div class="cit ref-cit ref-other" id="cit-22.4.646.12" data-doi="10.1067/mva.2000.107315"><div class="cit-metadata"><cite>Rapp JH, Pan XM, Sharp FR,  et al.  <strong>Atheroemboli to the brain: size threshold for causing acute neuronal cell 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 22</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 4 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Apr 2001 </div></div>
      
      
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      <div class="highwire-cite-title">Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Robert J.</span> <span class="nlm-surname">Feiwell</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Lavrentios</span> <span class="nlm-surname">Besmertis</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Rajabrata</span> <span class="nlm-surname">Sarkar</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">David A.</span> <span class="nlm-surname">Saloner</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Joseph H.</span> <span class="nlm-surname">Rapp</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2001, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">22 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">646-649; </span></div>
  
  
  
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      <div class="highwire-cite-title">Detection of Clinically Silent Infarcts after Carotid Endarterectomy by Use of Diffusion-weighted Imaging</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Robert J.</span> <span class="nlm-surname">Feiwell</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Lavrentios</span> <span class="nlm-surname">Besmertis</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Rajabrata</span> <span class="nlm-surname">Sarkar</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">David A.</span> <span class="nlm-surname">Saloner</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Joseph H.</span> <span class="nlm-surname">Rapp</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Apr 2001, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">22 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">646-649; </span></div>
  
  
  
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