Background Plaque protrusion (PP) inside stents on angiography or intravascular ultrasound during carotid artery stenting (CAS) is closely associated with ischemic complications and a significant increase in PP susceptibility with open cell stent use and unstable plaque.
Objectives We aimed to determine risk factors for PP using MR plaque imaging.
Methods We retrospectively analyzed 308 consecutive carotid atherosclerotic stenoses in 289 patients (men, 285; women, 43; symptomatic, n=126; mean age, 73.8 [range, 51–91] years; mean stenosis rate, 81.0%; range, 50%–99%) who underwent CAS and preoperative MR plaque imaging between October 2007 and March 2017. Signal intensity ratios (SIR) of carotid plaque relative to adjacent muscle were measured by MR plaque imaging. All CAS were performed using standard procedures with embolic protection devices. Open (OS) and closed (CS) cell stents were deployed in 262 and 102 arteries, respectively. SIRs were compared between groups with PP and without PP, and cutoffs were investigated in the group with PP.
Results PP occurred in 12 (3.9%) patients only in the OS group. The SIRs were 1.219±0.296 and 1.435±0.332 in the OS and CS groups, respectively, and significantly higher at 1.935±0.234 in the group with PP than without PP. The cutoff was 1.62 in the PP group.
Conclusions SIRs>1.62 in MR plaque images indicated a high risk of PP. In such cases, CS instead of OS should be used to avoid PP during CAS.
Disclosures K. Takayama: None. K. Myouchin: None. T. Wada: None. S. Kurokawa: None. K. Kichikawa: None.
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