Optical coherence tomography evaluation of tissue prolapse after carotid artery stenting using closed cell design stents for unstable plaque

Harada, Kei; Oshikata, Shogo; Kajihara, Masahito

doi:10.1136/neurintsurg-2017-013004

Cited by 25 publications

(24 citation statements)

References 26 publications

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“…Likewise, in another study the high resolution of OCT facilitated the identification of intimal hyperplasia, the internal and external elastic laminae, and echolucent regions, architecture that is difficult to discern with IVUS 24. Application of OCT technology to the carotid system has similarly yielded encouraging findings with studies reporting superior ability of OCT to visualize the near side of vessel luminal surface pathology, such as intraluminal thrombus or atherosclerotic fibrous cap disruption, and also plaque protrusion after stenting 28–30. From a technical perspective, one of the notable distinctions between IVUS and OCT would be the need to administer contrast media to acquire the high-definition images possible with OCT.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Ultrasound in Carotid Web

Hassani

Nogueira

Sachdeva

et al. 2019

J NeuroIntervent Surg

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BackgroundCarotid web (CaW) is a shelf-like linear filling defect in the posterior aspect of the internal carotid bulb, representing an intimal variant of fibromuscular dysplasia. The diagnosis of CaW is traditionally restricted to digital subtraction angiography (DSA), CT/MR angiography (CTA/MRA), and Duplex ultrasonography. In this series of patients with acute ischemic stroke, we evaluated the potential utility of intravascular ultrasound (IVUS) in further characterizing suspected CaWs.MethodsThis is a case series of three patients with suspected CaW who underwent DSA for treatment or investigation of large vessel occlusion strokes. In all cases the stroke investigation failed to identify an alternative cause, and the stroke etiology was attributed to a symptomatic CaW. The procedure consisted of positioning a guide catheter in the common carotid artery, navigating the IVUS probe distal to the carotid bulb, and then retracting the probe with a manual pullback. The acquired images were then reviewed in an independent workstationResultsIn two of the three cases, IVUS showed an isoechoic-to-hyperechoic focal eccentric area at the posterior carotid bulb, consistent with CaW. The endoluminal protrusion was inconspicuous on IVUS due to the low resolution of ultrasound not allowing a clear differentiation between fibrosis, thrombosis, and atherosclerosis. No abnormalities commonly associated with atherosclerotic disease or dissections were noted. The CaW could not be depicted in the third patient.ConclusionThe use of IVUS in the diagnosis of CaW may have limited relevance. Continued investigation of other imaging modalities for accurate CaW diagnosis is recommended.

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Section: Discussionmentioning

confidence: 99%

Intravascular Ultrasound in Carotid Web

Hassani

Nogueira

Sachdeva

et al. 2019

J NeuroIntervent Surg

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“…The Carotid Wallstent, which is a nitinol self-expanding closed-cell stent with a small free-cell area, is recommended for CAS, particularly with unstable plaques 18. However, slipping down or shortening of this stent has been reported,19 and Harada et al stated that even closed-cell stents may not solve the problem of unstable plaque tissue prolapse between struts using optical coherence tomography 20. Additionally, the risk of restenosis in the PRECISE stent is lower than that in the Carotid Wallstent.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques: analysis of 184 consecutive carotid artery stentings

Funakoshi¹,

Imamura

Tani

et al. 2019

J NeuroIntervent Surg

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IntroductionIn our institute, most cases of carotid artery stenosis are treated by carotid artery stenting (CAS) with an open-cell stent and double-balloon protection, even if plaques are unstable. This study was performed to examine the outcome of CAS with an open-cell stent and double-balloon protection for unstable plaques.MethodsA total of 184 CAS procedures in our institute between October 2010 and February 2018 were assessed. Ultrasonography findings of low-echo plaques, plaque ulceration, or both were defined as unstable plaques. A plaque-to-muscle ratio (PMR) of >1.8 on T1-weighted black blood imaging using spin-echo was also defined as an unstable plaque. Seventy-four unstable plaques on ultrasonography and 86 unstable plaques evaluated by PMR were included. Open-cell stents and double-balloon protection (proximal balloon protection during lesion crossing and distal balloon protection after lesion crossing) were used in all cases.ResultsOn ultrasonography, perioperative asymptomatic thromboembolization was significantly more frequent in the unstable plaque group (39/74, 52.7%) than in the stable plaque group (41/110, 37.3%, p=0.0384). Asymptomatic thromboembolization was also significantly more frequent in the PMR >1.8 group (44/86, 51.2%) than in the PMR <1.8 group (36/98, 36.7%, p=0.0489). However, symptomatic thromboembolization was rare (n=5, 2.7%), and all of these patients had minor stroke. During the 4-year follow-up, the risk of ipsilateral stroke was 0.28% and 0.27% per year in patients with symptomatic and asymptomatic lesions, respectively.ConclusionsThe outcomes of CAS with an open-cell stent and double-balloon protection are acceptable. This method is effective and safe, even if carotid artery stenosis comprises unstable plaques.

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“…1). 12,15,[19][20][21][22][23][24][25] Several limitations of carotid atherosclerotic OCT imaging exist. Clinicians have described satisfactory imaging without proximal balloon occlusion, though it is our institutional experience that the highest quality images are obtained with proximal occlusion.…”

Section: Current Optical Applicationsmentioning

confidence: 99%

Perspective review on applications of optics in cerebral endovascular neurosurgery

2019

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Cerebral endovascular neurosurgery has transformed the way we manage cerebrovascular disease. Several landmark trials have demonstrated the effectiveness of endovascular techniques leading to continued technological development and applications for various diseases. The utilization of optical technologies and devices is already underway in the field of endovascular neurosurgery. We discuss the contemporary paradigms, challenges, and current optical applications for the most common cerebrovascular diseases: carotid atherosclerotic disease, cerebral aneurysms, intracranial atherosclerosis, and dural arteriovenous fistulas. We also describe needs-based opportunities for future optical applications, with the goal of providing researchers a sense of where we feel optical technologies could impact the way we manage cerebral disease.

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Optical coherence tomography evaluation of tissue prolapse after carotid artery stenting using closed cell design stents for unstable plaque

Cited by 25 publications

References 26 publications

Intravascular Ultrasound in Carotid Web

Intravascular Ultrasound in Carotid Web

Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques: analysis of 184 consecutive carotid artery stentings

Perspective review on applications of optics in cerebral endovascular neurosurgery

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