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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:151-156, January 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Spontaneous Improvement of Peristent Ulceration after Carotid Artery Stenting

S. Kohyama^a, K. Kazekawa^a, M. Iko^a, H. Aikawa^a, M. Tsutsumi^a, Y. Go^a, S. Nagata^a, T. Kodama^a, K. Nii^a, S. Matsubara^a and A. Tanaka^a

^a Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan

Address correspondence to Kiyoshi Kazekawa, MD, Department of Neurosurgery, Fukuoka University Chikushi Hospital, 277-1 Zokumyoin, Chikushino, Fukuoka 8188502, Japan

Abstract

BACKGROUND AND PURPOSE: Because carotid plaque ulceration is associated with an increased risk of cerebral embolism, residual carotid plaque ulceration directly around a stent (peristent ulceration) after carotid angioplasty and stent placement (CAS) could still be a risk factor for a stroke. The purpose of this study is to understand the morphologic and clinical prognosis of peristent ulceration.

PATIENTS AND TECHNIQUES: CAS was attempted on 91 consecutive stenotic lesions (80 patients). Of these, 54 lesions (48 patients) had ulceration before CAS. Angiograms were evaluated immediately after the procedure. Peristent ulceration was found in 34 lesions (30 patients). The mean depth and length of peristent ulcers were 2.1 mm (range, 1–4.7 mm) and 8.9 mm (range, 1.5–22 mm), respectively. All patients with peristent ulceration were followed with antiplatelet therapy.

RESULTS: No ischemic event due to the lesions occurred during the mean follow-up period of 25.5 months (range, 3–48 months). Angiography on 25 lesions (21 patients) at a mean of 5.8 months (range, 1–21 months) after CAS showed that peristent ulceration disappeared in 12 lesions (48%), improved in 11 lesions (44%), and remained unchanged in 2 lesions (8%). Nine lesions (36%) showed restenosis, which were 30% and did not require any additional intervention. New ischemic lesions were not detected in any of the 14 patients (17 lesions) who underwent follow-up MR imaging at a mean of 9 months (range, 1–32 months) after CAS.

CONCLUSION: We conclude that peristent ulceration after CAS improves spontaneously and is not a risk factor for cerebral embolism.

This article has been cited by other articles:

				M. Onizuka, K. Kazekawa, S. Nagata, M. Tsutsumi, H. Aikawa, M. Tomokiyo, M. Iko, T. Kodama, K. Nii, S. Matsubara, et al. The Significance of Incomplete Stent Apposition in Patients Undergoing Stenting of Internal Carotid Artery Stenosis AJNR Am. J. Neuroradiol., August 1, 2006; 27(7): 1505 - 1507. [Abstract] [Full Text] [PDF]