Therapeutic Strategy for Carotid Artery Stenosis Based on Vessel Wall Imaging

• YOSHIDA Kazumichi

  Department of Neurosurgery, Kyoto University Graduate School of Medicine

• FUNAKI Takeshi

  Department of Neurosurgery, Kyoto University Graduate School of Medicine

• KIKUCHI Takayuki

  Department of Neurosurgery, Kyoto University Graduate School of Medicine

• TAKENOBU Yohei

  Department of Neurosurgery, Kyoto University Graduate School of Medicine

• ISHII Akira

  Department of Neurosurgery, Kyoto University Graduate School of Medicine

• TAKAGI Yasushi

  Department of Neurosurgery, Kyoto University Graduate School of Medicine

• MIYAMOTO Susumu

  Department of Neurosurgery, Kyoto University Graduate School of Medicine

Bibliographic Information

Other Title

• 血管壁評価を重視した頚動脈狭窄症に対する新たな治療戦略

Abstract

Guidelines in western countries for the management of carotid artery stenosis (CS) were formulated on the basis of the results of several randomized clinical trials (RCTs) in which risks of future ischemic events were estimated only based on luminal narrowing. Consequently, carotid endarterectomy (CEA) for symptomatic low-grade stenosis (LS) is not recommended and that for near occlusion (NO), which is a severe form of CS, is controversial because of the favorable outcomes of the medical treatments for LS and NO in the past RCTs. Luminal narrowing, however, does not necessarily reflect a significant burden of atherosclerotic plaque. Accumulating evidence from recent vascular biology studies and the advent of vessel wall imaging modalities, such as high-resolution magnetic resonance imaging (MRI), have indicated that plaque characteristics play pivotal roles in ischemic events. We report the therapeutic outcomes of CEA for LS and NO based on carotid MRI plaque characterization to assess its safety and efficacy. The study participants were comprised of 17 patients with LS and 11 with NO among 101 consecutive patients who underwent CEA by the same surgeon (K.Y.). For the patients with LS, MRI plaque characteristics, histology of the excised plaque, safety of CEA, and long-term outcome were retrospectively studied. For patients with NO, long-term patency of the distal carotid artery was also analyzed. The mean percentage of luminal stenosis was 31.6% ± 9.8%, and the MRI-detected intraplaque hemorrhage (IPH) and expansive remodeling (ER) were severe in the patients with LS. Histological studies demonstrated hemorrhage in all 17 plaques, ruptured fibrous cap in 15, and erosion with thrombosis in 2. The safety and long-term outcome of CEA with 57 months of follow-up were acceptable. In the patients with NO, CEA was performed without major adverse events in all the cases. Of the 5 patients with NO with full collapse, 3 who had an MRI-detected IPH demonstrated satisfactory patency of the distal internal carotid artery. Among the 2 patients without IPH, one had a collapsed distal ICA and the other showed an asymptomatic thrombotic occlusion. In addition to the percentage of luminal stenosis, plaque evaluation based on MRI-detected IPH and ER could be helpful for improving the management of CS by offering a more precise risk stratification for future ischemic events or efficacy prediction of CEA in patients with CS.

Journal

• Surgery for Cerebral Stroke

  Surgery for Cerebral Stroke 47 (2), 121-125, 2019

  The Japanese Society on Surgery for Cerebral Stroke

Keywords

• vessel wall imaging
• plaque characteristics
• carotid endarterectomy

Details

• CRID: 1390564238099176960
• NII Article ID: 130007661004
• DOI: 10.2335/scs.47.121
• ISSN: 18804683
• ISSN: 09145508
• Web Site: https://www.jstage.jst.go.jp/article/scs/47/2/47_121/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2019262403
• Text Lang: ja
• Data Source:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed