No abstract

Based on this early experience, carotid stenting appears feasible from a technical standpoint, with good midterm patency. However, the incidence of neurological sequelae is a serious problem. Technical enhancements and a more aggressive antiplatelet regimen may have a positive impact on these events.

This study showed a strong correlation between VH IVUS plaque characterization and the true histological examination of the plaque following endarterectomy, particularly in "vulnerable" plaque types. The feasibility study to examine VH IVUS data and the filter debris histology in CAS patients supports a larger prospective study.

Background-Carotid artery stenting (CAS) has recently emerged as a potential alternative to carotid endarterectomy.Cerebral embolization is the most devastating complication of CAS, and the echogenicity of carotid plaque has been indicated as one of the risk factors involved. This is the first study to analyze the role of a computer-assisted highly reproducible index of echogenicity, namely the gray-scale median (GSM), on the risk of stroke during CAS. Methods and Results-The Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) registry included 418 cases of CAS collected from 11 international centers. An echographic evaluation of carotid plaque with GSM measurement was made preprocedurally. The onset of neurological deficits during the procedure and the postprocedural period was recorded. The overall rate of neurological complications was 3.6%: minor strokes, 2.2%, and major stroke, 1.4%. There were 11 of 155 strokes (7.1%) in patients with GSM Յ25 and 4 of 263 (1.5%) in patients with GSM Ͼ25 (Pϭ0.005).Patients with severe stenosis (Ն85%) had a higher rate of stroke (Pϭ0.03). The effectiveness of brain protection devices was confirmed in those with GSM Ͼ25 (Pϭ0.01) but not in those with GSM Յ25. Multivariate analysis revealed that GSM (OR, 7.11; Pϭ0.002) and rate of stenosis (OR, 5.76; Pϭ0.010) are independent predictors of stroke. Conclusions-Carotid