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. 2018 May 15;58(5):191-198.
doi: 10.2176/nmc.oa.2017-0228. Epub 2018 Mar 3.

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

Yoshiro Ito  1 , Wataro Tsuruta  1 , Yasunobu Nakai  2 , Tomoji Takigawa  1 , Aiki Marushima  1 , Tomohiko Masumoto  3 , Yuji Matsumaru  4 , Eiichi Ishikawa  1 , Akira Matsumura  1
Affiliations

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

Yoshiro Ito et al. Neurol Med Chir (Tokyo). .

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.

Keywords: carotid artery stenting; carotid endarterectomy; internal carotid artery stenosis; plaque vulnerability; treatment risk evaluations.

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Conflict of interest statement

Conflicts of Interest Disclosure

YM received honoraria from Medtronic Japan and Stryker Japan for lecture fees. The other authors have no conflicts of interest. The authors registered online Self-reported COI Disclosure Statement Forms through the website for Japan Neurosurgical Society members.

Figures

Fig. 1.
Fig. 1.
(A) Treatment strategy based on plaque image and treatment risk evaluations for carotid artery stenosis. (B) The number of patients according to the classification.
Fig. 2.
Fig. 2.
Case 1: (A) Preoperative angiography reveals severe stenosis in the right internal carotid artery, which is tortuous. Preoperative magnetic resonance angiography (B) and carotid plaque imaging (C) shows unstable plaque. (D) Carotid endarterectomy was performed uneventfully.
Fig. 3.
Fig. 3.
Case 2: (A) Preoperative angiography reveals severe stenosis in the left internal carotid artery. (B) Preoperative carotid plaque imaging by MRI shows unstable plaque. (C) Carotid artery stenting was performed using filter protection under local anesthesia. During the procedure, disturbance of consciousness and conjugate deviation of the eyes to the left were observed. (D) Postoperative MRI reveals multiple cerebral infarctions.
See this image and copyright information in PMC

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