Safety of Protected Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis and Carotid Intraplaque Hemorrhage

Yoon, Woong; Kim, Seul-Kee; Park, M.S.; Chae, Hyeon-Seok; Kang, Heeyoung

doi:10.3174/ajnr.a2911

Cited by 16 publications

(24 citation statements)

References 26 publications

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“…In our study, the composite rate of 30-day stroke (minor or major), myocardial infarction, and death was 3.9%, which is lower than that of the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) trial. We also found no significant difference in primary outcomes after CAS between symptomatic and asymptomatic patients, which were consistent with findings of a similar, previous study (19).…”

Section: Outcome Based On Carotid Hr-mri Findingssupporting

confidence: 82%

“…However, Yoon et al (19) suggested that protected CAS is safe in patients with severe carotid stenosis and IPH. In a previous study from our group (20), we reported that IPH is not a significant risk factor for cerebral embolism during CAS in patients with severe carotid artery stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a group studied the relationship between the presence of unstable plaque such as IPH on carotid HR-MRI and the development of ischemic stroke in previously asymptomatic and symptomatic patients (18)(19)(20)(21). In particular, IPH is associated with plaque progression and consequently induces luminal narrowing (22,23).…”

Section: Introductionmentioning

confidence: 99%

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The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

Jeong

Kwak

Hwang

et al. 2018

J Korean Soc Radiol

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Purpose:The aim of this study was to determine the safety of the carotid artery stenting (CAS) procedure, using an embolic protection device which is based on the presence of unstable plaques on carotid MR imaging in patients who presented with severe carotid artery stenosis. Materials and Methods: This prospective study assessed 102 consecutive patients who had been noted with severe carotid stenosis. These patients underwent a preprocedural carotid MR imaging, and a periprocedural diffusion-weighted imaging (DWI) after the CAS. The unstable plaque on the carotid MR imaging was defined as characterized as intraplaque hemorrhage (IPH), thin/ruptured fibrous caps, or ulcers. We analyzed the incidence of the noted periprocedural ipsilateral ischemic events on the DWI, and noted the primary outcomes within 30 days of the CAS. Results: In the study, it is noted that 50 patients (49.0%) had IPH, 84 patients (82.4%) had thin/ruptured fibrous caps, and 43 patients (42.2%) had ulcers as seen on the carotid plaque MR imaging. The IPH was more common in the symptomatic group than in the asymptomatic group (58.7% vs. 41.1%, p = 0.12). Overall, the DWI was positive after CAS in 25.5% of cases. Additionally, the combined rate of 30-day stroke, myocardial infarction, or death was recorded at 3.9%. The new periprocedural ischemic lesions on the DWI were characteristically more frequently observed in the symptomatic group (17/46, 37.0%) than in the asymptomatic group (9/56, 16.1%) (p = 0.03). There was no significant difference in the primary outcome of the CAS, based on the type of unstable plaque of IPH, thin/ruptured fibrous caps, or ulcers. Conclusion:The protected CAS appears to be safe, regardless of the noted unstable plaque findings as seen on the carotid MR imaging. In this case, because of the higher risk of periprocedural ipsilateral ischemic events, it is therefore recommended that the symptomatic patients should receive more careful treatment during the CAS placement going forward. Korea. Tel. 82-63-250-2582 Fax. 82-63-272-0481 E-mail: kwak8140@jbnu.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Index terms

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Section: Outcome Based On Carotid Hr-mri Findingssupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

Jeong

Kwak

Hwang

et al. 2018

J Korean Soc Radiol

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“…These include conventional T1-weighted fast spin echo, TOF MRA, or MPRAGE sequences. Several studies have used TOF sequencing to detect carotid IPH, and a routine MRA protocol without additional sequences to evaluate carotid atherosclerosis (1,5,9,15). The appearance of a halo sign around the carotid artery on the MIP of the TOF MRA was useful for the noninvasive detection of a fresh or recent carotid IPH on histologic analysis (6,9).…”

Section: Discussionmentioning

confidence: 99%

“…The three T1-weighted sequences were two-dimensional (2D) fast spin-echo, three-dimensional (3D) time-of-flight (TOF), and threedimensional magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequence for detecting or quantifying IPH (1,(5)(6)(7)(8). Ota et al (8) reported on the diagnostic performance of three T1-weighted 3.0-T MR sequences at carotid IPH imaging, using histologic analysis as the standard of reference.…”

Section: Introductionmentioning

confidence: 99%

Carotid Intraplaque Hemorrhage Imaging: Diagnostic Value of High Signal Intensity Time-of-Flight MR Angiography Compared with Magnetization-Prepared Rapid Acquisition with Gradient-Echo Sequencing

Ahn

Kwak

Chung

et al. 2018

Investig Magn Reson Imaging

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Ischemic Stroke

Bradac

2014

Cerebral Angiography

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Safety of Protected Carotid Artery Stenting in Patients with Severe Carotid Artery Stenosis and Carotid Intraplaque Hemorrhage

Abstract: BACKGROUND AND PURPOSE:Carotid IPH can be detected with MR imaging. The aim of this study was to determine the safety of CAS using an emboli protection device in patients with severe carotid artery stenosis and MR imaging-depicted carotid IPH.

Cited by 16 publications

References 26 publications

The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

The Safety of Protected Carotid Artery Stenting in Patients with Unstable Plaque on Carotid High-Resolution MR Imaging

Carotid Intraplaque Hemorrhage Imaging: Diagnostic Value of High Signal Intensity Time-of-Flight MR Angiography Compared with Magnetization-Prepared Rapid Acquisition with Gradient-Echo Sequencing

Ischemic Stroke

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