Neurointervention.  2024 Mar;19(1):14-23. 10.5469/neuroint.2023.00486.

Findings of Angiography and Carotid Vessel Wall Imaging Associated with Post-Procedural Clinical Events after Carotid Artery Stenting

• Jeon S
• Park H
• Kwak HS
• Hwang SB

• KMID: 2552875
• DOI: http://doi.org/10.5469/neuroint.2023.00486

Abstract

Purpose
Vessel wall imaging (VWI) for carotid plaque is better for detecting unstable carotid plaque such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap. However, the role of VWI before carotid artery stenting (CAS) is unclear. Thus, this study aimed to determine the findings of symptomatic carotid stenosis before CAS on angiography and carotid VWI and to evaluate the imaging findings associated with post-procedural clinical events after CAS.
Materials and Methods
This retrospective study included 173 consecutive patients who underwent carotid VWI, CAS, and post-procedural diffusion-weighted imaging (DWI) after CAS. Findings of unstable plaque on carotid VWI and unstable findings on angiography were analyzed. We also analyzed the incidence of post-procedural clinical events, any stroke, myocardial infarction (MI), and death within 30 days of CAS.
Results
Of 173 patients, 101 (58.4%) had initial ischemic symptoms and positive findings on DWI. Symptomatic patients were significantly higher in patients with IPH than in patients without IPH (62.4% vs. 45.8%, P=0.031). Degree of stenosis, thrombus of the stenotic lesion, flow delay of internal carotid artery, and flow arrest by filter thrombus had significantly higher prevalence in the symptomatic group. Twenty patients (11.6%) had post-procedural clinical events such as any stroke, clinical symptoms, and/or MI. Hyperlipidemia and intraluminal thrombus on angiography were identified as significant factors influencing post-procedural events after CAS.
Conclusion
An intraluminal thrombus on angiography was identified as a significant factor influencing post-procedural clinical events after CAS.

Keyword

Carotid artery; Atherosclerosis; Vessel wall imaging; Stent; Angiography

Figure

• 

  Fig. 1. Imaging findings of carotid plaque magnetic resonance imaging (MRI). (A) Intraplaque hemorrhage (arrows). (B) Lipid-rich necrotic core (LRNC) and thin/ruptured fibrous cap. LRNC: non-enhanced area in the plaque on contrast-enhanced MRI (arrow). Thin/ruptured fibrous cap: non-enhanced fibrous cap. Vessel lumen (asterisk).

• 

  Fig. 2. Imaging findings of carotid angiography. (A) Intraluminal thrombus of the stenotic lesion (arrows). (B) Internal carotid artery (ICA) flow delay compared to external carotid artery. (C) ICA flow arrest by filter thrombus during carotid artery stenting (arrow).

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