Selection of Carotid Artery Stenting or Endarterectomy Based on Magnetic Resonance Plaque Imaging Reduced Periprocedural Adverse Events

doi:10.1016/j.jstrokecerebrovasdis.2012.07.018

Journal of Stroke and Cerebrovascular Diseases

Volume 22, Issue 7, October 2013, Pages 1082-1087

https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.07.018 Get rights and content

Background

The aim of this study was to elucidate the impact of treatment selection, either carotid stenting or endarterectomy, based on preoperative magnetic resonance (MR) plaque imaging on periprocedural events.

Methods

A total of 205 consecutive patients with high-grade carotid artery stenosis scheduled for elective revascularization with stenting or endarterectomy were retrospectively analyzed. In period 1, 95 patients were treated regardless of preoperative plaque imaging. In period 2, 110 patients received time of flight MR angiography, and endarterectomy was selected when a high-intensity signal in the plaque was observed on MR angiography because it indicated an unstable plaque. Periprocedural clinical results and outcome at 30 days were analyzed.

Results

In period 1, 5 patients (5.3%) were treated with endarterectomy and the other 90 patients (94.7%) were treated with stenting. In period 2, 35 patients (31.8%) were treated with endarterectomy and the other 75 patients (68.2%) were treated with stenting. Periprocedural adverse events, including any stroke, myocardial infarction, or death, were significantly more frequent in period 1 than in period 2 (9.5% v 1.8%; P = .034). Ischemic stroke was significantly reduced from period 1 to period 2 (7.4% v 0.9%; P = .043). Multivariate logistic regression analysis revealed “treatment selection by plaque imaging” was the only factor identified as an independent predictor of periprocedural events (P = .043).

Conclusions

Treatment selection based on preoperative plaque imaging appears useful for reducing periprocedural events of carotid artery revascularizations.

Section snippets

Study Protocol

This was a single-center retrospective analysis using MRI before CAS or CEA. The study protocol was approved by the institutional review board of Gifu University. A total of 205 consecutive patients with cervical carotid artery stenosis treated by elective CAS or CEA were involved in this study. Patients with carotid artery stenosis in a distal portion (i.e., petrous to intracranial carotid artery) and patients with progressive stroke treated by emergent intervention were excluded. Neurologic

Patient and Device Characteristics

The patient characteristics in periods 1 and 2 are shown in Table 1. No significant differences in sex, age, degree of stenosis, history, or medications were apparent between the 2 periods. EPDs were used in all patients treated using CAS in both periods. The rate of open/closed cell stenting did not differ significantly between periods.

Plaque Imaging

In period 2, preoperative TOF-MRA was performed in all 110 patients. HIS in the plaque on TOF-MRA was observed in 49 of 110 patients (44.5%), and CEA was

Discussion

Our study found that treatment selection based on preoperative plaque imaging using TOF-MRA reduced periprocedural events after carotid artery treatments. Periprocedural adverse events were significantly more frequent in period 1 than in period 2 (9.5% v 1.8%; P = .034), and minor stroke was significantly reduced from period 1 to period 2 (7.4% v 0.9%; P = .043). Therefore, treatment selection based on plaque findings from preoperative TOF-MRA—namely the application of CEA to HIS-positive

Acknowledgment

We thank Drs. Hara and Takamatsu of the Department of Tumor Pathology, Gifu University Graduate School of Medicine, for their histopathologic analysis.

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: Supported by the Research Grant Program of Gifu University Hospital, Gifu, Japan.

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Review ArticleSelection of Carotid Artery Stenting or Endarterectomy Based on Magnetic Resonance Plaque Imaging Reduced Periprocedural Adverse Events

Background

Methods

Results

Conclusions

Section snippets

Study Protocol

Patient and Device Characteristics

Plaque Imaging

Discussion

Acknowledgment

Lancet Neurol

Lancet Neurol

J Vasc Surg

J Vasc Surg

Atherosclerosis

Atherosclerosis

Stenting and angioplasty with protection in patients at high risk for endarterectomy investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients

N Engl J Med

CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis

N Engl J Med

Review Article
Selection of Carotid Artery Stenting or Endarterectomy Based on Magnetic Resonance Plaque Imaging Reduced Periprocedural Adverse Events