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Safety of Carotid Artery Stenting in Elderly Patients by Treatment Selection Based on Plaque Characteristics

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Abstract

Previous studies clarified that carotid endarterectomy has better outcomes in the elderly patients than carotid artery stenting. However, these studies did not evaluate the plaque characteristics of stenotic lesions. Therefore, we conducted a retrospective study to examine the safety and efficacy of carotid artery stenting with plaque evaluation in elderly patients. Overall, the data of 61 cases of 60 patients who underwent carotid artery stenting or carotid endarterectomy from October 2012 to December 2019 were included. The following data were compared between the carotid endarterectomy and carotid artery stenting cases: plaque characteristics on carotid magnetic resonance imaging (MRI), patient background characteristics, perioperative complications, prognosis, and presence of restenosis in patients aged > 70 years. Twenty-five patients aged > 70 years underwent carotid artery stenting, whereas 18 patients aged > 70 years underwent carotid endarterectomy. Carotid endarterectomy cases tended to have more unstable plaques characterized by high-intensity signals on carotid T1-weighted MRI images (carotid endarterectomy 12 cases (67%), carotid artery stenting 4 cases (16%); P: 0.0006). Perioperative complication occurred in two carotid artery stenting cases and one carotid endarterectomy case (carotid artery stenting 8%, CEA 5.6%; P: 0.75). The data of stroke, 30-day morbidity, modified Rankin Scale score after 90 days, and mortality showed no significant differences. Restenosis after intervention occurred in three carotid artery stenting cases and one carotid endarterectomy case. Carotid artery stenting can be safely performed even in elderly patients by selecting appropriate treatment based on plaque characteristics.

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All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

References

  1. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ et al (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501

    Article  CAS  PubMed  Google Scholar 

  2. Howard G, Roubin GS, Jansen O, Hendrikse J, Halliday A (2016) Fraedrich et al Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet 387:1305–11

    Article  PubMed  Google Scholar 

  3. Yuan C, Mitsumori LM, Beach KW, Maravilla KR (2001) Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. Radiology. 221(2):285–99

    Article  CAS  PubMed  Google Scholar 

  4. Yoshida K, Narumi O, Chin M, Inoue K, Tabuchi T, Oda K et al (2008) Characterization of carotid atherosclerosis and detection of soft plaque with use of black-blood MR imaging. Am J Neuroradiol 29(5):868–874

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kurosaki Y, Yoshida K, Fukuda H, Handa A, Chin M, Yamagata S et al (2017) Asymptomatic carotid T1-high-intense plaque as a risk factor for a subsequent cerebrovascular ischemic event. Cerebrovasc Dis 43(5–6):250–256

    Article  PubMed  Google Scholar 

  6. Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC et al (1999) The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 30(9):1751–1758

    Article  CAS  PubMed  Google Scholar 

  7. Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, Araki E et al (2010) Report of the committee on the classification and diagnostic criteria of diabetes mellitus. J Diabetes Investig 1:212–228

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cui L, Han Y, Zhang S, Liu X, Zhang J (2018) Safety of stenting and endarterectomy for asymptomatic carotid artery stenosis: a meta-analysis of randomised controlled trials. Eur J Vasc Endovasc Surg 55(5):614–624

    Article  PubMed  Google Scholar 

  9. Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP et al (2006) Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med 19(355):1660–1671

    Article  Google Scholar 

  10. Stingele R, Berger J, Alfke K, Eckstein HH, Fraedrich G, Allenberg J et al (2008) Clinical and angiographic risk factors for stroke and death within 30 days after carotid endarterectomy and stent-protected angioplasty: a subanalysis of the SPACE study. Lancet Neurol 7:216–222

    Article  PubMed  Google Scholar 

  11. Ringleb PA, Allenberg J, Brückmann H, Eckstein HH, Fraedrich G, Hartmann M et al (2006) 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368:1239–1247

    Article  CAS  PubMed  Google Scholar 

  12. Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ et al (2010) Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375:985–997

    Article  PubMed  Google Scholar 

  13. Voeks JH, Howard G, Roubin GS, Malas MB, Cohen DJ, Sternbergh WC 3rd et al (2011) Age and outcomes after carotid stenting and endarterectomy: the carotid revascularization endarterectomy versus stenting trial. Stroke 42:3484–3490

    Article  PubMed  PubMed Central  Google Scholar 

  14. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Yamada N, Higashi M, Otsubo R, Sakuma T, Oyama N, Tanaka R et al (2007) Association between signal hyperintensity on T1-weighted MR imaging of carotid plaques and ipsilateral ischemic events. Am J Neuroradiol 28(2):287–292

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Schindler A, Schinner R, Altaf N, Hosseini AA, Simpson RJ, Esposito-Bauer L et al (2020) Prediction of stroke risk by detection of hemorrhage in carotid plaques: meta-analysis of individual patient data. JACC Cardiovasc Imaging 13(2 Pt 1):395–406

    Article  PubMed  Google Scholar 

  17. Kotsugi M, Takayama K, Myouchin K, Wada T, Nakagawa I, Nakagawa H et al (2017) Carotid artery stenting: investigation of plaque protrusion incidence and prognosis. JACC Cardiovasc Interv 10(8):824–831

    Article  PubMed  Google Scholar 

  18. Spence JD (2017) Transcranial Doppler monitoring for microemboli: a marker of a high-risk carotid plaque. Semin Vasc Surg 30(1):62–66

    Article  PubMed  Google Scholar 

  19. Tanemura H, Maeda M, Ichikawa N, Miura Y, Umeda Y, Hatazaki S et al (2013) High-risk plaque for carotid artery stenting evaluated with 3-dimensional T1-weighted gradient echo sequence. Stroke 44:105–110

    Article  PubMed  Google Scholar 

  20. Yoshimura S, Yamada K, Kawasaki M, Asano T, Kanematsu M, Takamatsu M et al (2011) High-intensity signal on time-of-flight magnetic resonance angiography indicates carotid plaques at high risk for cerebral embolism during stenting. Stroke 42:3132–3137

    Article  PubMed  Google Scholar 

  21. Mutzenbach SJ, Millesi K, Roesler C, Broussalis E, Pikija S, Sellner J et al (2018) The Casper stent system for carotid artery stenosis. J Neurointerv Surg 10(9):869–873

    Article  PubMed  Google Scholar 

  22. Diaz O, Lopez G, Roehm JOF Jr, De la Rosa G, Orozco F, Almeida R (2018) The Casper carotid artery stent: a unique all metal micromesh stent designed to prevent embolic release. J Neurointerv Surg 10(2):133–136

    Article  PubMed  Google Scholar 

  23. Musiałek P, Roubin GS (2019) Commentary: Double-layer carotid stents: from the clinical need, through a stent-in-stent strategy, to effective plaque isolation the journey toward safe carotid revascularization using the endovascular route. J Endovasc Ther 26(4):572–577

    Article  PubMed  Google Scholar 

  24. Musialek P, Mazurek A, Trystula M, Borratynska A, Lesniak-Sobelga A, Urbanczyk M et al (2016) Novel PARADIGM in carotid revascularisation: prospective evaluation of All-comer peRcutaneous cArotiD revascularisation in symptomatic and Increased-risk asymptomatic carotid artery stenosis using CGuard MicroNet-covered embolic prevention stent system. EuroIntervention 12(5):e658–e670

    Article  PubMed  Google Scholar 

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Acknowledgements

Preparation of this manuscript is supported by Kansai Electric Power Medical Research Institute.

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Authors and Affiliations

  1. Department of Neurosurgery, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka, 553-0003, Japan

    Morio Takasaki & Ryota Miyake

  2. Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan

    Mayu Kamei & Ryosuke Sakai

Authors
  1. Morio Takasaki
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  2. Ryota Miyake
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  3. Mayu Kamei
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  4. Ryosuke Sakai
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Contributions

Acquisition of data: Mayu Kamei, and Ryosuke Sakai.

Analysis and interpretation of data: Ryota Miyake.

Corresponding author

Correspondence to Morio Takasaki.

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Ethics Approval

The study protocol was reviewed and approved by ethical committee of Kansai Electric Power Hospital, approval number [21–066].

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The authors declare no competing interests.

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Takasaki, M., Miyake, R., Kamei, M. et al. Safety of Carotid Artery Stenting in Elderly Patients by Treatment Selection Based on Plaque Characteristics. Indian J Surg 85 (Suppl 1), 301–305 (2023). https://doi.org/10.1007/s12262-022-03585-z

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  • DOI: https://doi.org/10.1007/s12262-022-03585-z

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