Cerebral Embolism during Carotid Artery Stenting: Role of Carotid Plaque Echolucency

Rosenkranz, Michael; Wittkugel, Oliver; Waiblinger, C.; Thomalla, Götz; Krützelmann, Anna; Havemeister, Stefanie; Zeumer, H.; Gerloff, Christian; Fiehler, Jens

doi:10.1159/000209239

Cited by 26 publications

(22 citation statements)

References 53 publications

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“…Assessment of carotid plaque morphology has been shown to improve the prediction of stroke risk [18]. Particularly carotid plaque echolucency in b-mode ultrasound and the length of the target plaque have been shown to predict embolic events and stroke associated with carotid revascularization [6,19,20,21]. Echolucent carotid plaques are associated with ischemic cerebrovascular events not only during carotid revascularization, but also without such interventions [22], which suggests that echolucent plaques may be instable.…”

Section: Discussionmentioning

confidence: 99%

“…Both solid and gaseous MES have been reported to be independently associated with procedure-related ipsilateral ischemic strokes [21]. The number of ipsilateral solid MES during CAS has been reported to be higher in patients with echolucent plaques than in those with echogenic plaques, which suggests an association between plaque morphology and solid embolization during CAS [20,21]. The use of MES as a surrogate marker for the risk of stroke allowed us to evaluate the role of carotid plaque surface irregularity as a potential risk factor of CAS in a study with only a small number of subjects.…”

Section: Discussionmentioning

confidence: 99%

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Carotid Plaque Surface Irregularity Predicts Cerebral Embolism during Carotid Artery Stenting

et al. 2011

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Background and Purpose: Carotid artery stenting (CAS) is associated with the risk of periprocedural embolic events. The procedural risk may vary with plaque characteristics. We aimed at determining the impact of carotid plaque surface irregularity on the risk of cerebral embolism during CAS. Methods: Solid microembolic signals (MES) during CAS for symptomatic carotid stenosis were assessed by means of dual-frequency transcranial Doppler ultrasound. Study endpoint was the number of solid MES during CAS in 12 patients with irregular carotid stenosis compared to 12 matched patients with smooth carotid stenosis. Results: A total of 438 solid MES were detected. The cumulative number of solid MES was 329 in patients with irregular plaques and 109 in those with smooth plaques. The proportion of subjects in whom solid MES were detected was higher in the irregular plaque group (11/12) than in the smooth plaque group (5/12) (p = 0.030). The numbers of solid MES per CAS procedure and per hour of CAS procedure were both higher in patients with irregular plaques than in those with smooth plaques (p = 0.008 and 0.015, respectively). Conclusions: Carotid plaque surface irregularity predicts solid cerebral embolism during stenting of symptomatic carotid artery stenosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Carotid Plaque Surface Irregularity Predicts Cerebral Embolism during Carotid Artery Stenting

et al. 2011

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“…For instance, echolucent carotid plaques on B-mode ultrasound are associated with procedural embolization [25] and neurological complications during CAS [26]. As VH-IVUS is somewhat invasive, we always performed an IVUS study after the EPD placement to prevent embolic complications caused by the IVUS procedure.…”

Section: Discussionmentioning

confidence: 99%

Fibro-Fatty Volume of Culprit Lesions in Virtual Histology™ Intravascular Ultrasound Is Associated with the Amount of Debris during Carotid Artery Stenting

et al. 2010

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Objectives: This study aimed to evaluate the relationship between the amount of aspirated debris during distal balloon-protected carotid artery stenting (CAS) and the pre-intervention plaque composition, as assessed by Virtual Histology™ (VH) intravascular ultrasound (IVUS). Methods: The study subjects were 25 consecutive patients (mean age, 73.0 ± 5.2 years; 20 males and 5 females) who underwent CAS under distal balloon protection. The average rate of carotid stenosis was 74.6 ± 12.9% by North American Symptomatic Carotid Endarterectomy Trial criteria. We assessed culprit plaque components by VH-IVUS before CAS. Aspirated debris was filtered, stained with HE and mounted onto glass slides. The quantity of debris was evaluated by measuring its surface area. We evaluated the relationship between the quantity of aspirated debris and VH-IVUS measurements before CAS. Results: The amount of debris during CAS was positively correlated with the total plaque volume in grayscale IVUS (Rs = 0.480, p = 0.015) and fibro-fatty volumes over the entire lesion length in VH-IVUS (Rs = 0.561, p = 0.001). Conclusions: Culprit lesions with large plaque volumes, especially larger fibro-fatty volumes, as imaged by VH-IVUS, are associated with large amounts of debris during balloon-protected CAS.

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“…7 In the case of carotid stenting, plaque composition has been associated with risk of periprocedural embolic events and early ipsilateral stroke. [21][22][23] In the case of endarterectomy, MRI-detected ulcerated, irregular plaque surface has been reported to be associated with increased rates of periprocedural embolization. 24 We do not have detailed plaque imaging (echo-Doppler or MRI) for the majority of patients in this study.…”

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Histological Features of Carotid Plaque in Patients With Ocular Ischemia Versus Cerebral Events

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Redgrave

et al. 2013

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T he risk of ipsilateral ischemic stroke in patients with recent ocular ischemic events is less than half that of otherwise similar patients with recent cerebral ischemic events, [1][2][3] and in those with carotid stenosis, their prognosis is similar to that in patients with asymptomatic stenosis. 4,5 Consequently, in patients with ≥70% carotid artery stenosis in the European Carotid Surgery Trial and North American Symptomatic Carotid Endarterectomy Trial (NASCET), the absolute reduction in 5-year risk of ipsilateral ischemic stroke with surgery was ≈5% for patients with recent ocular events and 17% for those with cerebral events, 4,5 despite a lower procedural risk in the patients with ocular events only. 4,5 Across all carotid endarterectomy trials and case-series, the 30-day risk of stroke in patients with ocular ischemic events is less than half that in patients with cerebral events independent of degree of carotid artery stenosis, 6 and the same difference has been observed in the procedural risk of carotid stenting. 7The reasons for the relatively low risk of ipsilateral ischemic stroke in patients with carotid stenosis and ocular ischemic events are not fully understood. However, the fact that these patient groups have the same prevalence of previous coronary heart disease and peripheral vascular disease and the same risk of future coronary events 5,[8][9][10] suggests that the lower stroke risk in patients with ocular events only may reflect differences in local carotid plaque pathology. The only previous study comparing histological plaque features from patients with ocular versus cerebral ischemic events suggested that patients with ocular events may have more stable plaques, 11 but the number of cases was too small to allow reliable adjustment for differences in other risk factors. We aimed to study carotid plaque composition in a larger number of consecutive patients undergoing carotid endarterectomy for symptomatic stenosis to compare features in those who had cerebral events within the last 6 months versus those with ocular events only.Background and Purpose-Patients with carotid artery stenosis and ocular ischemic events have a much lower risk of future ipsilateral ischemic stroke on medical treatment and lower procedural risks for endarterectomy and stenting than patients with cerebral ischemic events, and are closer in risk to patients with asymptomatic stenosis. The reasons for this difference in prognosis are not fully understood, but may reflect differences in carotid plaque pathology. Methods-In consecutive patients undergoing carotid endarterectomy for recently symptomatic stenosis (Oxford Plaque Study, Athero-Express Study), we compared carotid plaque histology (using validated semiquantitative scales) in those who had cerebral events within the last 6 months (n=1317) versus those with ocular events only (n=323 All patients (and their relevant imaging) were reviewed by a neurologist before carotid endarterectomy. Patients were categorized as having only ocular ischemic events or cerebral...

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Cerebral Embolism during Carotid Artery Stenting: Role of Carotid Plaque Echolucency

Cited by 26 publications

References 53 publications

Carotid Plaque Surface Irregularity Predicts Cerebral Embolism during Carotid Artery Stenting

Carotid Plaque Surface Irregularity Predicts Cerebral Embolism during Carotid Artery Stenting

Fibro-Fatty Volume of Culprit Lesions in Virtual Histology™ Intravascular Ultrasound Is Associated with the Amount of Debris during Carotid Artery Stenting

Histological Features of Carotid Plaque in Patients With Ocular Ischemia Versus Cerebral Events

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