Cerebral embolism during carotid artery stenting: role of carotid plaque echolucency
Michael Rosenkranz1, Oliver Wittkugel, Christian Waiblinger
1Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Carotid artery stenting (CAS) carries stroke risk. Echolucent carotid plaques, identified by lower gray scale median (GSM), are linked to higher rates of cerebral embolism during CAS procedures.
Area of Science:
- Neuroscience
- Vascular Surgery
- Medical Imaging
Background:
- Carotid artery stenting (CAS) procedures carry an inherent risk of intraprocedural stroke.
- Identifying specific risk factors for cerebral embolism during CAS is crucial for improving patient outcomes.
- This study investigates carotid plaque echolucency as a potential predictor of cerebral embolism during CAS.
Purpose of the Study:
- To evaluate the role of carotid plaque echolucency, measured by gray scale median (GSM), in predicting cerebral embolism during carotid artery stenting (CAS).
- To determine if plaque echolucency is a significant risk factor for intraprocedural embolism in patients undergoing CAS.
Main Methods:
- Prospective evaluation of 31 patients undergoing CAS for symptomatic high-grade carotid stenosis.
- Carotid plaque echolucency was quantified using computer-assisted gray scale median (GSM).
- Dual-frequency transcranial Doppler ultrasound monitored for solid cerebral microemboli during CAS procedures.
Main Results:
- Solid cerebral microemboli were detected in 17 out of 27 evaluable CAS procedures.
- Plaques with lower GSM (indicating higher echolucency) were associated with a higher incidence of intraprocedural embolism (p=0.040).
- Receiver-operating characteristic analysis identified a GSM of 50 as a threshold, with 85% embolism risk for echolucent plaques (GSM <50) versus 42% for echogenic plaques (GSM >=50) (p=0.031).
Conclusions:
- Carotid artery stenting (CAS) of both echolucent and echogenic plaques can be associated with cerebral embolism.
- Echolucent carotid plaques (lower GSM) appear to carry a higher risk of intraprocedural embolism during CAS.
- Plaque echolucency is a valuable factor but should be considered alongside other risk factors for comprehensive patient risk assessment during CAS.
Background:
Carotid artery stenting (CAS) is associated with the risk of intraprocedural stroke. A better understanding of specific risk factors could help to improve the procedure and to reduce the overall risk of CAS. We addressed the role of carotid plaque echolucency as potential risk factor for cerebral embolism during CAS.
Methods:
We prospectively evaluated carotid plaque echolucency by use of a computer-assisted measure of echogenicity, the gray scale median (GSM), in 31 consecutive patients with symptomatic high-grade carotid stenosis that were scheduled to undergo CAS. Dual-frequency transcranial Doppler ultrasound was used to detect solid cerebral microemboli during CAS.
Results:
27 of the 31 patients met all inclusion/exclusion criteria.Solid cerebral microemboli were detected during 17 of 27 CAS procedures. The GSM of the target plaques was lower in subjects with intraprocedural embolism (37.9 +/- 20.8) than in those without (58.2 +/- 25.7) (p = 0.040). A receiver-operating characteristic analysis showed that the GSM that gave the greatest separation between plaques with a higher and a lower probability of intraprocedural embolism was 50: the proportion of subjects with intraprocedural embolism was 85% in CAS of echolucent plaques (GSM <50) and 42% in CAS of echogenic plaques (GSM > or =50) (p = 0.031).
Conclusions:
CAS of both echolucent and echogenic carotid plaques may be associated with cerebral embolism, particularly CAS of echolucent plaques. Plaque echolucency alone does not reliably identify patients at particularly high risk of intraprocedural embolism, but should be considered as one of a broad panel of risk factors of CAS.
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