Selection of Carotid Artery Stenting or Endarterectomy Based on Magnetic Resonance Plaque Imaging Reduced Periprocedural Adverse Events

• Published in: Journal of stroke and cerebrovascular diseases Vol. 22; no. 7; pp. 1082 - 1087
• Main Authors: Yoshimura, Shinichi, MD, PhD, Yamada, Kiyofumi, MD, PhD, Kawasaki, Masanori, MD, PhD, Asano, Takahiko, MD, Kanematsu, Masayuki, MD, Miyai, Masafumi, MD, Enomoto, Yukiko, MD, PhD, Egashira, Yusuke, MD, Iwama, Toru, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2013
• Subjects: Aged; Aged, 80 and over; Cardiovascular; Carotid artery stenting; carotid endarterectomy; carotid plaques; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; cerebral infarction; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - methods; Female; Humans; Magnetic Resonance Angiography; magnetic resonance imaging; Male; Middle Aged; Neurology; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - surgery; Radiography; Retrospective Studies; Stents - adverse effects; Treatment Outcome; magnetic resonance imaging; carotid endarterectomy; Carotid artery stenting; cerebral infarction; carotid plaques
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.018

Background The aim of this study was to elucidate the impact of treatment selection, either carotid stenting or endarterectomy, based on preoperative magnetic resonance (MR) plaque imaging on periprocedural events. Methods A total of 205 consecutive patients with high-grade carotid artery stenosis scheduled for elective revascularization with stenting or endarterectomy were retrospectively analyzed. In period 1, 95 patients were treated regardless of preoperative plaque imaging. In period 2, 110 patients received time of flight MR angiography, and endarterectomy was selected when a high-intensity signal in the plaque was observed on MR angiography because it indicated an unstable plaque. Periprocedural clinical results and outcome at 30 days were analyzed. Results In period 1, 5 patients (5.3%) were treated with endarterectomy and the other 90 patients (94.7%) were treated with stenting. In period 2, 35 patients (31.8%) were treated with endarterectomy and the other 75 patients (68.2%) were treated with stenting. Periprocedural adverse events, including any stroke, myocardial infarction, or death, were significantly more frequent in period 1 than in period 2 (9.5% v 1.8%; P = .034). Ischemic stroke was significantly reduced from period 1 to period 2 (7.4% v 0.9%; P = .043). Multivariate logistic regression analysis revealed “treatment selection by plaque imaging” was the only factor identified as an independent predictor of periprocedural events ( P  = .043). Conclusions Treatment selection based on preoperative plaque imaging appears useful for reducing periprocedural events of carotid artery revascularizations.