Author + information
- Received December 9, 2016
- Revision received January 2, 2017
- Accepted January 27, 2017
- Published online April 17, 2017.
- Masashi Kotsugi, MDa,∗ (, )
- Katsutoshi Takayama, MDb,
- Kaoru Myouchin, MDb,
- Takeshi Wada, MDc,
- Ichiro Nakagawa, MDd,
- Hiroyuki Nakagawa, MDc,
- Toshiaki Taoka, MDc,
- Shinichiro Kurokawa, MDa,
- Hiroyuki Nakase, MDd and
- Kimihiko Kichikawa, MDc
- aDepartments of Neurosurgery, Ishinkai Yao General Hospital, Yao, Japan
- bDepartment of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
- cDepartment of Radiology, Nara Medical University, Nara, Japan
- dDepartment of Neurosurgery, Nara Medical University, Nara, Japan
- ↵∗Address for correspondence:
Dr. Masashi Kotsugi, Departments of Neurosurgery, Ishinkai Yao General Hospital, 1-41 Numa Yao, Osaka 581-0036, Japan.
Objectives This study sought to clarify the incidence and prognosis of PP in carotid artery stenting (CAS).
Background Projections thought to be plaque may be observed inside the stent on angiography or intravascular ultrasound (IVUS) during CAS. Known as plaque protrusion (PP), the incidence and prognosis of this complication are unclear.
Methods A total of 354 consecutive carotid atherosclerotic stenoses in 328 patients (285 men, 43 women; age range 51 to 97 years [mean age 73.6 years]; 158 symptomatic cases; stenosis rate, 50% to 99% [mean 81.0%]) who underwent CAS under IVUS between October 2007 and March 2016 were retrospectively analyzed. PP was defined as plaque seen inside the stent lumen on both digital subtraction angiography and IVUS. The incidence and prognosis (rate of stroke within 30 post-operative days) of PP and the rate of ischemic lesions on the treated side on diffusion-weighted imaging performed within 48 post-operative hours within the PP group were investigated.
Results PP was observed in 9 cases (2.6%). Ischemic stroke occurred in 6 of 9 PP cases (66.7%; 1 major, 5 minor). Ischemic lesions were observed on diffusion-weighted imaging in 8 of 9 cases (88.9%). PP was strongly associated with perioperative ischemic stroke. A significant increase in PP susceptibility was observed with open-cell stent use and unstable plaque.
Conclusions The incidence of PP in CAS was 2.6%, with a high risk of ischemic complications if PP was observed. The present findings indicate the necessity of appropriate device selection to avoid PP.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 9, 2016.
- Revision received January 2, 2017.
- Accepted January 27, 2017.
- 2017 American College of Cardiology Foundation