Carotid artery stenting in asymptomatic and surgically high-risk patients: Single-centre, single-operator results

Veselka, Josef; Zimolová, Petra; Černá, Daniela; Stanka, P; Tomek, Aleš; Šrámek, Martin

doi:10.1055/s-0031-1278311

Int J Angiol

2008

DOI: 10.1055/s-0031-1278311

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Carotid artery stenting in asymptomatic and surgically high-risk patients: Single-centre, single-operator results

Josef Veselka

Petra Zimolová²,

Daniela Černá³

et al.

Abstract: Short-term outcomes of CAS in asymptomatic, surgically high-risk patients treated by a single operator suggest a low periprocedural complication rate.

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“…We have learned that safely performed carotid endarterectomy can improve the long-term outcome, and carotid artery stenting can be comparable to endarterectomy in selected patients. [1][2][3] However, all these largely discussed and often justifiably criticized studies have been based on the angiographic, ultrasound, and/or computed tomographic measurement of the severity of atherosclerotic disease resulting in a simple assessment of diameter stenosis. Thus, atherosclerotic plaque composition, which might be the main factor of lesion-related vulnerability, has not been recognized.…”

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Atherosclerotic Plaque Composition Is Still an Almost Unrecognized Factor of Risk Stratification in Patients with Carotid Artery Disease

Veselka

2015

Int J Angiol

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Int J Angiol 2015;24:155-156. Stroke represents the third leading cause of death and the leading cause of disability in developed countries. Atherosclerosis of the carotid arteries is common in the adult and elderly population, and is a major risk factor of cerebral ischemia. Therefore, carotid artery revascularization seems to be an important therapeutic method with a potentially large impact on the incidence of cerebrovascular events and related mortality.Several randomized and nonrandomized studies dealing with the optimal therapeutic approach to severe atherosclerotic disease of carotid arteries were published in the last two decades. We have learned that safely performed carotid endarterectomy can improve the long-term outcome, and carotid artery stenting can be comparable to endarterectomy in selected patients. 1-3 However, all these largely discussed and often justifiably criticized studies have been based on the angiographic, ultrasound, and/or computed tomographic measurement of the severity of atherosclerotic disease resulting in a simple assessment of diameter stenosis. Thus, atherosclerotic plaque composition, which might be the main factor of lesion-related vulnerability, has not been recognized. Since "the Devil is in the details," I believe that future studies should avoid the persistent simplification in carotid diagnostics and focus their attention much more on plaque composition.Of course, carotid plaque composition has been investigated as a means of therapeutic stratification in a few studies. [4][5][6][7] It has been presumed that plaques that are more vulnerable have a large lipid and necrotic core size, which may subsequently lead to distal embolization. Therefore, we began speculating that better determination of plaque morphology and composition could predict the future embolic potential and help in selecting the best therapeutic approach. Several invasive and noninvasive methods have been used to determine plaque composition, but still, there is an ongoing debate as to which produces the most relevant results.One of the invasive imaging methods that were associated with promising expectations was virtual histologyintravascular ultrasound (VH-IVUS). This examination uses spectral analysis of radiofrequency ultrasound backscatter signals from the IVUS images to define the four components of atherosclerotic plaque-fibrous, fibrofatty, calcified, and necrotic core. Unfortunately, carotid plaque composition determined by VH-IVUS only weakly correlated with the degree of cerebral embolization during or immediately after carotid artery stenting. 6 In addition, it has been suggested that a necrotic core, as defined by VH-IVUS, was not definitely associated with subclinical cerebral embolization after carotid artery stenting under embolic protection. 6 Another invasive diagnostic technique is the near-infrared spectroscopy (NIRS), which has been developed for the identification of a lipid core within an atherosclerotic lesion. This is achieved by determination of the lesion's chemical composi...

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Atherosclerotic Plaque Composition Is Still an Almost Unrecognized Factor of Risk Stratification in Patients with Carotid Artery Disease

Veselka

2015

Int J Angiol

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Carotid artery stenting in asymptomatic and surgically high-risk patients: Single-centre, single-operator results

Abstract: Short-term outcomes of CAS in asymptomatic, surgically high-risk patients treated by a single operator suggest a low periprocedural complication rate.

Cited by 1 publication

References 23 publications

Atherosclerotic Plaque Composition Is Still an Almost Unrecognized Factor of Risk Stratification in Patients with Carotid Artery Disease

Atherosclerotic Plaque Composition Is Still an Almost Unrecognized Factor of Risk Stratification in Patients with Carotid Artery Disease

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