Patterns of Acute Ischemic Strokes After Carotid Endarterectomy and Therapeutic Implications

Aim:Acute ischemic strokes following surgical treatment of carotid stenosis lead to substantial disability and mortality, and vascular mechanisms underlying their development are not fully elucidated. The goal of this study was to analyze the topographic patterns of acute ischemic stroke following carotid endarterectomy (CEA) on diffusion-weighted and perfusion-weighted magnetic resonance imaging (MRI).Material and Methods:Data were retrospectively collected from consecutive patients who underwent CEA and developed postoperative acute ischemic stroke. Based on the MRI data sets, the lesion patterns of acute stoke were characterized. Morphology of the circle of Willis, the 3-D time-of-flight (3D-TOF) of the cerebral arteries, and status of the carotid circulation were also analyzed in order to determine the vascular mechanisms involved in stroke development.Results:Between January 2008 and May 2015, 821 patients were treated surgically for a symptomatic or asymptomatic carotid stenosis at the University Ho...