Treatment Strategy Based on Plaque Vulnerability and the Treatment Risk Evaluation for Internal Carotid Artery Stenosis

Abstract

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are not appropriate treatment procedure for internal carotid artery stenosis (ICAS) in some patients. The importance of plaque vulnerability and the treatment risk evaluation has been reported. We analyzed whether treatment selection contributes to the outcome. We retrospectively examined 121 patients who underwent CEA or CAS. Treatment was selected based on plaque vulnerability and the treatment risk evaluation. We selected CAS for patients with stable plaques and CEA for patients with unstable plaques, and considered the other treatment for high-risk patients. The patients were classified as the stable plaque (Stable: n = 42), the unstable plaque and CEA low risk (Unstable/Low: n = 30), and the CEA high-risk (Unstable/High: n = 49). Frequency of perioperative stroke, myocardial infarction, death, and systemic complications was examined. CEA and CAS were performed in 35 and 86 patients, respectively. One patient (2.9%) had a stroke in CEA and five patients (5.8%) in CAS (P = 0.50). Systemic complications were observed in two patients (5.7%) in CEA and six (7.1%) in CAS (P = 0.80). There were no differences in stroke (Stable; 2.4%, Unstable/Low; 3.2%, and Unstable/High; 8.2%) and systemic complications (Stable; 9.5%, Unstable/Low; 3.3%, and Unstable/High; 6.1%) among three groups (P = 0.44 and P = 0.59, respectively). The treatment selection based on plaque vulnerability and the treatment risk evaluation could provide good treatment outcome for high-risk patients. It is ideal to select an appropriate treatment for ICAS by one neurovascular team.

Gradual Expansion of a Stent to Prevent Periprocedural Complications after Carotid Artery Stenting for Vulnerable Severe Stenotic Lesions with Intraplaque Hemorrhages: A Retrospective Observational Study

“…Previous studies have reported the double-balloon protection technique for vulnerable lesions [4,30]. This technique is rational but complicated as a routine procedure.…”

“…Plaque imaging has been developed, and carotid plaque lesions that show hyperintensities on magnetic resonance (MR) images are considered as lesions with IPH [3]. Appropriate surgical treatment is necessary for lesions with IPH [4]. Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) and is applied in CEA high-risk patients [5].…”

Hypothesis of “stroke-stop” formula: a tool for risk index determination in development of acute cerebrovascular disease in asymptomatic individuals with carotid stenosis

“…Therefore, the criteria for selecting patients for surgical prevention of acute cerebrovascular disease among asymptomatic individuals with carotid stenosis are broadly discussed nowadays [13,14]. There have been several studies, where in addition to atherosclerotic ICA stenosis, the morphological structure of the atherosclerotic plaque was taken into consideration [15][16][17][18]. In recent years, researchers have widely investigated vascular inflammatory markers as well as the relationship between their concentration and the risk of developing atherosclerotic complications [19].…”

Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note

“…1 – 3) Currently, it is recommended to select the treatment according to the characteristics of the case. 1 , 4 , 5) In cases with a difficult access route, CEA is usually performed, but CAS is sometimes performed in cases with other risk factors. CAS for cases with a difficult access route are classified into two types: CAS in which it is difficult to insert a guiding catheter owing to conditions such as aortic disease or a type III aortic arch 6 , 7) and CAS in which it is difficult to pass a device through a lesion such as severe stenosis or highly tortuous vessels.…”