Findings of Angiography and Carotid Vessel Wall Imaging Associated with Post-Procedural Clinical Events after Carotid Artery Stenting.

IF 1.2 Q4 CLINICAL NEUROLOGY Neurointervention Pub Date : 2024-03-01 Epub Date: 2024-01-17 DOI:10.5469/neuroint.2023.00486
Sujin Jeon, Heejae Park, Hyo Sung Kwak, Seung Bae Hwang
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Abstract

Purpose: Vessel wall imaging (VWI) for carotid plaque is better for detecting unstable carotid plaque such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thin/ruptured fibrous cap. However, the role of VWI before carotid artery stenting (CAS) is unclear. Thus, this study aimed to determine the findings of symptomatic carotid stenosis before CAS on angiography and carotid VWI and to evaluate the imaging findings associated with post-procedural clinical events after CAS.

Materials and methods: This retrospective study included 173 consecutive patients who underwent carotid VWI, CAS, and post-procedural diffusion-weighted imaging (DWI) after CAS. Findings of unstable plaque on carotid VWI and unstable findings on angiography were analyzed. We also analyzed the incidence of post-procedural clinical events, any stroke, myocardial infarction (MI), and death within 30 days of CAS.

Results: Of 173 patients, 101 (58.4%) had initial ischemic symptoms and positive findings on DWI. Symptomatic patients were significantly higher in patients with IPH than in patients without IPH (62.4% vs. 45.8%, P=0.031). Degree of stenosis, thrombus of the stenotic lesion, flow delay of internal carotid artery, and flow arrest by filter thrombus had significantly higher prevalence in the symptomatic group. Twenty patients (11.6%) had post-procedural clinical events such as any stroke, clinical symptoms, and/or MI. Hyperlipidemia and intraluminal thrombus on angiography were identified as significant factors influencing post-procedural events after CAS.

Conclusion: An intraluminal thrombus on angiography was identified as a significant factor influencing post-procedural clinical events after CAS.

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血管造影和颈动脉血管壁成像结果与颈动脉支架植入术后临床事件的相关性
目的:颈动脉斑块的血管壁成像(VWI)能更好地检测不稳定的颈动脉斑块,如斑块内出血(IPH)、富脂坏死核心(LRNC)和薄/破裂的纤维帽。然而,颈动脉支架置入术(CAS)前使用 VWI 的作用尚不明确。因此,本研究旨在确定 CAS 前血管造影和颈动脉 VWI 对无症状颈动脉狭窄的发现,并评估与 CAS 术后临床事件相关的影像学发现:这项回顾性研究纳入了173例连续接受颈动脉VWI、CAS和CAS术后弥散加权成像(DWI)的患者。对颈动脉血管造影(VWI)发现的不稳定斑块和血管造影发现的不稳定斑块进行了分析。我们还分析了CAS术后30天内的临床事件、任何中风、心肌梗死(MI)和死亡的发生率:在173名患者中,101人(58.4%)有初始缺血症状,DWI检查结果呈阳性。有症状的 IPH 患者明显多于无 IPH 患者(62.4% 对 45.8%,P=0.031)。无症状组中狭窄程度、狭窄病变血栓、颈内动脉血流延迟和滤过性血栓阻断血流的发生率明显更高。有 20 名患者(11.6%)在手术后发生了中风、临床症状和/或心肌梗死等临床事件。结论:高脂血症和血管造影显示的腔内血栓是影响CAS术后事件的重要因素:结论:血管造影发现的腔内血栓是影响 CAS 术后临床事件的重要因素。
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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
34
审稿时长
12 weeks
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