Article Text

PDF
Original research
Optical coherence tomography evaluation of tissue prolapse after carotid artery stenting using closed cell design stents for unstable plaque
  1. Kei Harada,
  2. Shogo Oshikata,
  3. Masahito Kajihara
  1. Department of Neuro-Vascular Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan
  1. Correspondence to Dr K Harada, Department of Neuro-Vascular Surgery, Fukuoka Wajiro Hospital Heart and Neuro-Vascular Center, 2-2-75, Wajirogaoka, Higashi-ku, Fukuoka-city, Fukuoka Wajiro Hospital, Fukuoka 811-0213, Japan; keihara{at}f-wajirohp.jp

Abstract

Background and purpose During carotid artery stenting (CAS) with the use of closed cell design stents for unstable plaques, tissue prolapse between stent struts was evaluated by optical coherence tomography (OCT).

Methods 14 carotid stenosis lesions diagnosed as unstable plaques by MRI were evaluated by OCT imaging during CAS using closed cell stents. Cross sectional OCT images within the stented segment were evaluated at 1 mm intervals. The slice rate for the presence of tissue prolapse between the struts was calculated.

Results No intra-procedural complications occurred. After single stent placement, plaque prolapse was observed in all cases. Slices with any and >500 µm tissue prolapse were seen in 30% and 7.8% of cases, respectively. In 5 of 7 lesions with tissue prolapse >500 µm, additional stents were overlapped. In cases with overlapping stents, slices with any tissue prolapse were significantly decreased from 26% to 16% (p=0.008); in particular, the occurrence of tissue prolapse >500 µm was significantly decreased from 15% to 2.3% (p<0.001). In one case of >500 µm tissue prolapse without an overlapping stent, delayed embolization due to an in-stent thrombus occurred 9 months after the procedure.

Conclusions OCT during CAS using closed cell stent for unstable plaques frequently revealed tissue prolapse between struts. Placement of overlapping stents significantly reduced tissue prolapse, particularly tissue prolapse >500 µm. However, closed cell stents used for unstable plaques may not solve the problem of tissue prolapse.

  • Stent
  • Plaque
  • Stenosis

Statistics from Altmetric.com

Footnotes

  • Contributors KH was the main operator of the endovascular treatment, designed the research, and drafted the manuscript. SO and MK were the main assistants in the endovascular treatment and reviewed the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the ethics committee of Fukuoka Wajiro Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.