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Takao N, Hagiwara Y, Shimizu T, Soga K, Tsuchihashi Y, Otsubo H, Tatsuno K, Takaishi S, Usuki N, Yoshie T, Takada T, Ueda T, Hasegawa Y, Yamano Y. Preprocedural Carotid Plaque Echolucency as a Predictor of In-Stent Intimal Restenosis after Carotid Artery Stenting. J Stroke Cerebrovasc Dis 2020; 29:105339. [PMID: 33032020 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES In-stent intimal restenosis (ISR) caused by neointimal hyperplasia can develop <24 months after carotid artery stenting (CAS). The utility of plaque imaging by carotid ultrasonography (US) or magnetic resonance imaging (MRI) has been investigated for the prediction of ipsilateral stroke. We aimed to investigate whether these imaging techniques are useful for detecting carotid plaques prone to ISR. MATERIALS AND METHODS We examined 133 patients (mean age of 72.1 ± 8.4 years old) that received CAS at a single hospital from 2014 to 2018. A pre-CAS carotid plaque evaluation was performed by carotid angiography, duplex carotid US, and black-blood carotid artery MRI (BB-MRI). The mean stenosis rate was 71.0 ± 12.3% by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) methods. Follow-up carotid angiography was performed 6 months after CAS in all patients according to a predefined protocol. ISR was defined as in-stent intimal hyperplasia more than 50% stenosed based on the NASCET criteria. The selection of the stent type was at the discretion of the treating physician. Predictors of ISR were determined by multivariate logistic regression analysis. RESULTS Follow-up angiography demonstrated ISR in 33 patients (24.8%). In 44 patients, more than two stents were deployed. Univariate logistic regression analyses demonstrated echolucent lesion, floating plaque, complete occlusive or pseudo-occlusive lesion, and closed-cell stent use as significantly associated with ISR (>50%). Multivariate logistic regression analysis demonstrated that echolucent lesion (OR 4.667, 95% CI 1.849-11.779) and closed-cell stent use (OR .378, 95% CI .148-.968) were significantly associated with ISR. CONCLUSIONS Preprocedural plaque characterization by carotid US appeared to be useful to predict ISR 6 months after CAS.
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Affiliation(s)
- Naoki Takao
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Yuta Hagiwara
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
| | - Takahiro Shimizu
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Kaima Soga
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Yoko Tsuchihashi
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Haruki Otsubo
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Kentaro Tatsuno
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Satoshi Takaishi
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Noriko Usuki
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Tomohide Yoshie
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Tatsuro Takada
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Toshihiro Ueda
- Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Yasuhiro Hasegawa
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
| | - Yoshihisa Yamano
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
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Kuwahara S, Matsukawa H, Yamada K, Uchida K, Shirakawa M, Yoshimura S. A Patient with Carotid Mobile Plaques Treated by Carotid Artery Stenting Using a Double-layer Micromesh Stent. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:495-500. [PMID: 37501767 PMCID: PMC10370942 DOI: 10.5797/jnet.cr.2019-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/08/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of carotid mobile plaques treated by carotid artery stenting (CAS) using a double-layer micromesh stent (CASPER stent). Case Presentation An 86-year-old male presented with lightheadedness. Carotid artery ultrasound revealed mobile plaques in the right internal carotid artery (ICA). Head and neck MRI demonstrated concomitant left ICA occlusion. We first started medical treatment, but it could not reduce the plaque size. Then, we performed CAS using a CASPER stent in addition to medical treatment. The procedure was finished without complications, and there was no plaque protrusion. The postoperative course was uneventful during 3 years of follow-up. Conclusion A mobile plaque of the carotid artery may be treated less-invasively with a micromesh stent.
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Affiliation(s)
- Shuntaro Kuwahara
- Department of Neurosurgery, Goshi Hospital, Amagasaki, Hyogo, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Han M, Choi J, Seo GS, Nam HS. Carotid Artery Disease in Duplex Sonography: 3 Cases. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2019. [DOI: 10.15324/kjcls.2019.51.1.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Minho Han
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea
- Department of Science for Aging, Yonsei University Graduate School, Seoul, Korea
| | - Junghye Choi
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea
| | - Gang Sik Seo
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea
| | - Hyo Suk Nam
- Department of Science for Aging, Yonsei University Graduate School, Seoul, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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