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. 2015;55(2):149-54.
doi: 10.2176/nmc.oa.2014-0105. Epub 2015 Jan 23.

Evaluation and management of plaque protrusion or thrombus following carotid artery stenting

Naoki Hashimura  1 , Tatsushi Mutoh, Kazuya Matsuda, Keigo Matsumoto
Affiliations

Evaluation and management of plaque protrusion or thrombus following carotid artery stenting

Naoki Hashimura et al. Neurol Med Chir (Tokyo). 2015.

Abstract

Carotid artery stenting (CAS) has become a common treatment for carotid artery stenosis. However, complications, such as an ischemic event, can occur with CAS during intra- and post-operative periods. Among these ischemic complications, plaque protrusion into the stent and thrombus on the stent have occurred after CAS. We retrospectively evaluated the temporal profile and treatment options for these complications in 32 consecutive cases who underwent CAS at our hospital between April 2009 and December 2011. The cases were evaluated pre-operatively for risk factors, as well as the plaque morphology and characteristics using computed tomographic angiography (CTA), ultrasound (US), and magnetic resonance imaging (MRI). Post-operatively, lesions were examined by CTA and/or US within 1 week of CAS. As a result, among the 32 cases, 8 experienced plaque protrusions or thrombus, which were treated with medication (anti-platelet and/or anti-coagulation reinforcement). In 7 of these 8 cases, the plaque protrusion or thrombus was stabilized with medication alone. However, the remaining case showed growth and migration of the plaque protrusion or thrombus when treated with medication alone, and therefore, required further endovascular treatment. We identified that a history of symptomatic cerebral infarction and plaques with ulceration were risk factors for plaque protrusion or thrombus formation after CAS, and pre dilatation can decrease the risk of these complications. Medication was effective in most cases of plaque protrusion or thrombus; however, further endovascular treatment was required when medication alone was unsuccessful.

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Conflict of interest statement

Conflicts of Interest Disclosure

The authors have no conflict of interest and have registered Online Self-reported Conflict of Interest Disclosure Statement Forms through the website for Japan Neurosurgical Society members.

Figures

Fig. 1.
Fig. 1.
(Case 8). Images of representative case of medically treatable plaque protrusion or thrombus. A: CTA on the 2nd day after CAS, the arrow shows plaque protrusion or thrombus in the stent. B: CTA on the 6th day, arrowhead shows plaque protrusion or thrombus got small. C: DSA before CAS. D: DSA after CAS. CAS: carotid artery stenting, CTA: computed tomographic angiography, DSA: digital subtraction angiography.
Fig. 2.
Fig. 2.
(Case 7). Images of representative case of plaque protrusion or thrombus that required further endovascular therapy. A: CTA on the 5th day after CAS. B: CTA on the 9th day after CAS. C: Intravascular ultrasound before the treatment of plaque protrusion or thrombus, asterisk shows plaque protrusion or thrombus. D: Intravascular ultrasound after the treatment of plaque protrusion or thrombus. E: DSA before the 1st CAS. F: DSA after the 1st CAS. G: DSA before the 2nd CAS. H: DSA after the 2nd CAS. CAS: carotid artery stenting, CTA: computed tomographic angiography, DSA: digital subtraction angiography.
See this image and copyright information in PMC

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