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. 2024 May 20;60(5):836.
doi: 10.3390/medicina60050836.

Assessment of Plaque Characteristics by Contrast-Enhanced Ultrasound and Stent Restenosis following Carotid Artery Stenting: A Retrospective Study

Agnė Gimžauskaitė  1 , Donatas Inčiūra  1 , Gintautė Diringytė  2 , Saulius Lukoševičius  3 , Rytis Kaupas  3 , Andrius Pranculis  3 , Aistė Mačiulaitytė  1 , Algidas Basevičius  3 , Milda Kuprytė  4 , Edgaras Stankevičius  5 , Jurgita Plisienė  6
Affiliations

Assessment of Plaque Characteristics by Contrast-Enhanced Ultrasound and Stent Restenosis following Carotid Artery Stenting: A Retrospective Study

Agnė Gimžauskaitė et al. Medicina (Kaunas). .

Abstract

Background and objective: carotid artery stenosis contributes significantly to ischemic strokes, with management options including carotid endarterectomy (CEA) and carotid artery stenting (CAS) ischemic stroke risk can be reduced. Controversies persist regarding their efficacy and factors influencing complications, and understanding the relationship between atherosclerotic plaque characteristics and stent restenosis after CAS is crucial. Methods: we conducted a retrospective study involving 221 patients who underwent CAS for symptomatic or asymptomatic carotid artery stenosis. Comprehensive assessments of plaque morphology were performed using contrast-enhanced ultrasound (CEUS) before CAS. Patient demographics, including smoking status and diabetes, were also recorded. Stent restenosis was diagnosed using various imaging modalities, including ultrasound, angiography, and digital subtraction angiography (DSA). Results: plaque analysis using CEUS revealed a significant association between plaque grade and restenosis incidence (p < 0.001), particularly with grade 0 (11.1%) and grade 2 plaques (66.7%). Smoking was notably associated with plaque vascularization and restenosis (p < 0.001), while diabetes did not significantly impact plaque characteristics or restenosis risk (p > 0.05). The mean duration of restenosis was 17.67 months. Stenting was the most frequent treatment modality for restenosis (70.6%). However, no significant relationship was found between restenosis type and plaque morphology (p = 0.268). Furthermore, while no clear relationship was observed between plaque morphology and the type of restenosis, our findings underscored the importance of plaque characterization in predicting post-CAS outcomes. Conclusions: this study highlights the utility of CEUS in predicting stent restenosis following CAS. There was a significant association between stent restenosis within 12-24 months after the carotid stenting procedure and an elevated grade of plaque vascularization. Moreover, one of the main factors possibly determining the grade of plaque vascularization was smoking. Further research is warranted to elucidate the underlying mechanisms and refine risk stratification in this patient population.

Keywords: carotid artery disease; carotid stent restenosis; carotid stenting; contrast-enhanced ultrasound.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Representative CEUS (left) and grayscale ultrasound (right) images of a grade 2 plaque. The red curved line shows the plaque margins.
Figure 2
Figure 2
Representative CEUS (left) and grayscale ultrasound (right) images of a grade 1 plaque. The red curved line shows the plaque margins.
Figure 3
Figure 3
Representative CEUS image showing neovascularization with a red arrow.
Figure 4
Figure 4
Types of restenosis after the stenting procedure [22].
See this image and copyright information in PMC

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