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Carotid plaque with expansive arterial remodeling is a risk factor for ischemic complication following carotid artery stenting

  • Original Article - Vascular
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Abstract

Background

Carotid artery stenting (CAS) is associated with a higher risk of periprocedural stroke than carotid endarterectomy. For better patient selection, more accurate risk factors should be identified. The aim of this study was to determine whether expansive arterial remodeling can predict ischemic complications in patients undergoing CAS.

Methods

This retrospective study included 82 patients with carotid stenosis treated by CAS. The plaque component was evaluated using MR plaque imaging before the procedure. Following the procedure, lesion assessment was performed using MRI diffusion-weighted imaging (DWI), and patients were classified as DWI positive or negative for comparison between groups.

Results

Fifteen patients were classified as DWI positive and 67 patients as DWI negative. The mean expansive remodeling rate was 1.76 ± 0.21 in the DWI-positive group and 1.35 ± 0.18 in the DWI-negative group (P < 0.001). Receiver-operating characteristic analysis revealed that the threshold for the expansive remodeling rate separating the two groups was 1.52 (area under the curve = 0.933). The positive predictive value of postoperative new DWI lesions in the high-intensity plaque associated with a high expansive remodeling rate was 64.3%, and the negative predictive value of the isointensity plaque associated with a low expansive remodeling rate was 97.8%. These values were higher than those of the plaque component alone (32.1% and 81.7%, respectively).

Conclusions

This study revealed that expansive arterial remodeling is a strong risk predictor of ischemic complication in CAS. Expansive remodeling rate measurements are very simple and provide useful information for determining treatment strategies for patients with carotid stenosis.

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Authors and Affiliations

  1. Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan

    Daina Kashiwazaki, Naoya Kuwayama, Naoki Akioka & Satoshi Kuroda

  2. Department of Radiology, Graduate School of Medicine and Pharmacological Sciences, University of Toyama, Toyama, Japan

    Kyo Noguchi

Authors
  1. Daina Kashiwazaki
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  2. Naoya Kuwayama
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  3. Naoki Akioka
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  4. Kyo Noguchi
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  5. Satoshi Kuroda
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Corresponding author

Correspondence to Daina Kashiwazaki.

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Funding

All authors received no funding for this research.

Conflict of interest

None.

Ethical approval

For this type of study, formal approval is not required.

Informed consent

Informed consent was obtained from all individual patients included in this study.

Additional information

Comments

This is a sage and salient contribution from a highly experienced carotid surgery group. The message is clear; high-risk plaques with extensive remodeling have a materially higher risk of new DWI lesions post-CAS. These data can guide us all to best stratify and optimize patients for surgery or CAS. My only criticism is that the majority of the patients were asymptomatic, and if they had co-morbidities that would otherwise render them high-risk (not discussed in this article), many of us experienced in carotid reconstruction would consider observational treatment alone for this class of patients.

Christopher Miranda Loftus

PA, USA

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Kashiwazaki, D., Kuwayama, N., Akioka, N. et al. Carotid plaque with expansive arterial remodeling is a risk factor for ischemic complication following carotid artery stenting. Acta Neurochir 159, 1299–1304 (2017). https://doi.org/10.1007/s00701-017-3188-y

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  • DOI: https://doi.org/10.1007/s00701-017-3188-y

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