Acta Neurochirurgica

, Volume 159, Issue 7, pp 1299–1304 | Cite as

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

  • Daina Kashiwazaki
  • Naoya Kuwayama
  • Naoki Akioka
  • Kyo Noguchi
  • Satoshi Kuroda
Original Article - Vascular

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.

Keywords

Carotid artery stenting Carotid stenosis Expansive artery remodeling 

References

  1. 1.
    Akutsu N, Hosoda K, Fujita A, Kohmura E (2012) A preliminary prediction model with MR plaque imaging to estimate risk for new ischemic brain lesions on diffusion-weighted imaging after endarterectomy or stenting in patients with carotid stenosis. AJNR Am J Neuroradiol 33:1557–1564CrossRefPubMedGoogle Scholar
  2. 2.
    Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF, Investigators C (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Siddiq F, Adil MM, Malik AA, Qureshi MH, Qureshi AI (2015) Effect of carotid revascularization endarterectomy versus stenting trial results on the performance of carotid artery stent placement and carotid endarterectomy in the United States. Neurosurgery 77:726–732 discussion 732CrossRefPubMedGoogle Scholar
  4. 4.
    European Carotid Surgery Trialists' Collaborative Group (1998) Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) Lancet 351:1379–1387Google Scholar
  5. 5.
    Biasi GM, Froio A, Diethrich EB, Deleo G, Galimberti S, Mingazzini P, Nicolaides AN, Griffin M, Raithel D, Reid DB, Valsecchi MG (2004) Carotid plaque echolucency increases the risk of stroke in carotid stenting: the imaging in carotid angioplasty and risk of stroke (ICAROS) study. Circulation 110:756–762CrossRefPubMedGoogle Scholar
  6. 6.
    Lanzer P, Weser R, Prettin C (2006) Carotid-artery stenting in a high-risk patient population—single centre, single operator results. Clin Res Cardiol 95:4–12CrossRefPubMedGoogle Scholar
  7. 7.
    Mathur A, Roubin GS, Iyer SS, Piamsonboon C, Liu MW, Gomez CR, Yadav JS, Chastain HD, Fox LM, Dean LS, Vitek JJ (1998) Predictors of stroke complicating carotid artery stenting. Circulation 97:1239–1245CrossRefPubMedGoogle Scholar
  8. 8.
    Safian RD, Bresnahan JF, Jaff MR, Foster M, Bacharach JM, Maini B, Turco M, Myla S, Eles G, Ansel GM, Investigators CPT (2006) Protected carotid stenting in high-risk patients with severe carotid artery stenosis. J Am Coll Cardiol 47:2384–2389CrossRefPubMedGoogle Scholar
  9. 9.
    Kurosaki Y, Yoshida K, Fukumitsu R, Sadamasa N, Handa A, Chin M, Yamagata S (2016) Carotid artery plaque assessment using quantitative expansive remodeling evaluation and MRI plaque signal intensity. J Neurosurg 124:736–742CrossRefPubMedGoogle Scholar
  10. 10.
    Yoshida K, Fukumitsu R, Kurosaki Y, Funaki T, Kikuchi T, Takahashi JC, Takagi Y, Yamagata S, Miyamoto S (2015) The association between expansive arterial remodeling detected by high-resolution MRI in carotid artery stenosis and clinical presentation. J Neurosurg 123:434–440CrossRefPubMedGoogle Scholar
  11. 11.
    Kashiwazaki D, Akioka N, Kuwayama N, Noguchi K, Tanaka K, Kuroda S (2015) Pathophysiology of acute cerebrovascular syndrome in patients with carotid artery stenosis: a magnetic resonance imaging/single-photon emission computed tomography study. Neurosurgery 76:427–433CrossRefPubMedGoogle Scholar
  12. 12.
    O’Rourke MF, Hashimoto J (2007) Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol 50:1–13CrossRefPubMedGoogle Scholar
  13. 13.
    Nakamura M, Nishikawa H, Mukai S, Setsuda M, Nakajima K, Tamada H, Suzuki H, Ohnishi T, Kakuta Y, Nakano T, Yeung AC (2001) Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol 37:63–69CrossRefPubMedGoogle Scholar
  14. 14.
    Varnava AM, Mills PG, Davies MJ (2002) Relationship between coronary artery remodeling and plaque vulnerability. Circulation 105:939–943CrossRefPubMedGoogle Scholar
  15. 15.
    Rodriguez-Granillo GA, Serruys PW, Garcia-Garcia HM, Aoki J, Valgimigli M, van Mieghem CA, McFadden E, de Jaegere PP, de Feyter P (2006) Coronary artery remodelling is related to plaque composition. Heart 92:388–391CrossRefPubMedGoogle Scholar
  16. 16.
    Takemoto K, Ueba T, Takano K, Abe H, Hirata Y, Higashi T, Inoue T, Sakata N, Yoshimitsu K (2013) Quantitative evaluation using the plaque/muscle ratio index panels predicts plaque type and risk of embolism in patients undergoing carotid artery stenting. Clin Neurol Neurosurg 115:1298–1303CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Daina Kashiwazaki
    • 1
  • Naoya Kuwayama
    • 1
  • Naoki Akioka
    • 1
  • Kyo Noguchi
    • 2
  • Satoshi Kuroda
    • 1
  1. 1.Departments of Neurosurgery, Graduate School of Medicine and Pharmaceutical ScienceUniversity of ToyamaToyamaJapan
  2. 2.Department of Radiology, Graduate School of Medicine and Pharmacological SciencesUniversity of ToyamaToyamaJapan

Personalised recommendations