The Virtual histology In CaroTids Observational RegistrY (VICTORY) study: A European prospective registry to assess the feasibility and safety of intravascular ultrasound and virtual histology during carotid interventions

Highly‐calcific carotid lesions endovascular management in symptomatic and increased‐stroke‐risk asymptomatic patients using the CGuard™ dual‐layer carotid stent system: Analysis from the PARADIGM study

“…Although significant calcification is considered a late stage in the atherosclerotic lesion evolution, 26 the HCCS pathology is not benign as it may be associated with the clinical symptoms of transient ischemic attack and stroke 26,27 (note 37% symptomatic patients in the HCCS present study cohort, Table 3). HCCS patients with increased-strokerisk lesion characteristics may require intervention to minimize stroke risk.…”

“…What is “moderate” calcification according to one may be considered “severe” (or vice versa) by another operator or analyst. Thus far, angiography‐based algorithms have been proposed to evaluate calcification severity in the peripheral arteries (typically superficial femoral artery [SFA]) but not in the carotid territory where the lesion characteristics show several peculiarities and where management tools have been limited in relation to the peripheral arteries such as SFA. Therefore, development of a simple (and applicable in routine practice) yet informative angiographic scoring system to grade carotid calcification has been critically important.…”

“…One significant limitation of the present analysis is moderate size of the HCCS group. Furthermore, presently we have not routinely applied additional imaging modalities such as computed tomography angiography or intravascular imaging . Rather, we have deliberately focused on the parameters of routine (practical) imaging that is easily available in all patients with carotid stenosis subjected to angiography.…”

“…Furthermore, presently we have not routinely applied additional imaging modalities such as computed tomography angiography 25 or intravascular imaging. 5,27,[33][34][35] Rather, we have deliberately focused on the parameters of routine (practical) imaging that is easily available in all patients with carotid stenosis subjected to angiography. Finally, our pilot angiogram-based quantitative data such as calcification intensity and volume (that are not part of the presently proposed algorithm) may require validation in an ex-vivo model.…”

Editorial comment: sandwich carotid stenting: too much of a good thing?

“…Yet, preprocedural appraisal remains crucial in all patients in whom carotid artery stenting is envisioned, as recent clinical instability, soft plaque features at non-invasive imaging, and systemic inflammation might all contribute to an increased risk of in-stent plaque protrusion [10,11]. Indeed, invasive imaging, based on intravascular ultrasound, possibly also encompassing color-flow imaging and virtual histology, notwithstanding the niche role of optical coherence tomography, can prove quite useful for complex interventions, highlighting subtle complications such as edge dissection, intervening thrombus, or plaque protrusion [12,13].…”