The utility of high-resolution magnetic resonance imaging in the detection of fibrotic plaques associated with chronic internal carotid artery occlusion.

OBJECTIVE

High-resolution VWI is a non-invasive technique for evaluating atherosclerotic plaque composition. This study aims to delineate the characteristics of VWI and DSA in CICAO patients with highly fibrotic plaques, enhancing preoperative identification.

METHODS

This retrospective study included patients with CICAO who underwent VWI and DSA before surgical intervention at our hospital from 2017 to 2024. Patients were categorized based on histopathological findings into two groups: those with highly fibrotic plaques and those with significant necrotic cores. A comparative analysis assessed differences in VWI and DSA characteristics between the groups. Imaging features were also summarized for five patients who underwent bypass surgery after unsuccessful interventional recanalization attempts.

RESULTS

Five cases of CICAO were included, confirmed to have highly fibrotic plaques, while 22 cases had plaques with significant necrotic cores. The fibrotic plaques showed greater T1 isointensity on VWI (p=0.0005), while the necrotic cores exhibited higher signals on VWI T2 sequences and a trend toward conical residuals on DSA. In cases of failed interventional recanalization requiring bypass surgery, VWI showed T1 isointensity (40%) and T2 high signals (80%), while DSA indicated blunt or absent residuals (80%).

CONCLUSION

Clinical physicians can identify CICAO with fibrotic plaques using preoperative VWI and DSA, enabling them to select hybrid surgical techniques that enhance intervention success.

ABBREVIATIONS: CICAO, chronic internal carotid artery occlusion; DSA, digital subtraction angiography; VWI, vessel wall imaging; MRA, magnetic resonance angiography; CTA, computed tomography angiography; CEA, carotid endarterectomy.