Review ArticleSelection of Carotid Artery Stenting or Endarterectomy Based on Magnetic Resonance Plaque Imaging Reduced Periprocedural Adverse Events
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.
References (16)
- et al.
Endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis (EVA-3S) trial: Results up to 4 years from a randomised, multicentre trial
Lancet Neurol
(2008) - et al.
Results of the stent-protected angioplasty versus carotid endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: A multinational, prospective, randomised trial
Lancet Neurol
(2008) - et al.
Ex vivo human carotid artery bifurcation stenting: Correlation of lesion characteristics with embolic potential
J Vasc Surg
(1998) - et al.
Correlates of embolic events detected by means of transcranial Doppler in patients with carotid atheroma
J Vasc Surg
(2001) - et al.
Embolic complications after carotid artery stenting or carotid endarterectomy are associated with tissue characteristics of carotid plaques evaluated by magnetic resonance imaging
Atherosclerosis
(2011) - et al.
Prediction of silent ischemic lesions after carotid artery stenting using integrated backscatter ultrasound and magnetic resonance imaging
Atherosclerosis
(2010) - et al.
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
(2004) - et al.
CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis
N Engl J Med
(2010)
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Supported by the Research Grant Program of Gifu University Hospital, Gifu, Japan.