Aortic arch and common carotid artery plaques with soft components pose a substantial risk of cerebral embolization during carotid stenting

Péter Szikra, K. Boda, Ferenc Rarosi, A. Thury, P. Barzó, Tamás Németh, E. Vörös

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives A higher rate of embolization is considered a disadvantage of carotid stenting (CAS), when compared with carotid endarterectomy. Plaques in the aortic arch (AA) and the common carotid artery (CCA) may be additional sources of embolization to stented internal carotid plaques during CAS. In this study, we aimed to investigate the relationship between these plaques and intracerebral embolization. Methods We analyzed the occurrence and composition of plaques in the AA and CCA by computed tomography angiography (CTA) in 101 consecutive cases of CAS. Cases of peri-procedural embolization were detected on diffusion-weighted imaging as lesions demonstrating diffusion restriction. We applied the χ2 and Fisher's exact tests, as well as logistic regression models. Results The occurrence of plaques in the AA and CCA was significantly related to the appearance of new diffusion-weighted imaging lesions (p = 0.013 and p = 0.004, respectively). Patients with soft plaques in the AA or CCA had a significantly higher risk of embolization than those without plaques (p = 0.012 and p = 0.006, respectively). In contrast, homogeneously calcified plaques did not pose significantly higher risks. Conclusions Soft plaques in the AA and CCA result in a substantial risk of embolization during CAS. Use of a CTA examination of the AA and the CCA in patients with carotid stenosis may help to select lower-risk patients for CAS.

Original languageEnglish
Pages (from-to)438-444
Number of pages7
JournalInterventional Neuroradiology
Volume22
Issue number4
DOIs
Publication statusPublished - Aug 1 2016

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Carotid Stenosis
Common Carotid Artery
Thoracic Aorta
Logistic Models
Carotid Endarterectomy

Keywords

  • Aortic arch
  • arterial plaque
  • calcified plaque
  • carotid artery
  • carotid stenosis
  • carotid stenting
  • cerebral embolism
  • computed tomographic angiography
  • diffusion-weighted imaging
  • embolism
  • risk factors
  • soft plaque

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Aortic arch and common carotid artery plaques with soft components pose a substantial risk of cerebral embolization during carotid stenting. / Szikra, Péter; Boda, K.; Rarosi, Ferenc; Thury, A.; Barzó, P.; Németh, Tamás; Vörös, E.

In: Interventional Neuroradiology, Vol. 22, No. 4, 01.08.2016, p. 438-444.

Research output: Contribution to journalArticle

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AB - Objectives A higher rate of embolization is considered a disadvantage of carotid stenting (CAS), when compared with carotid endarterectomy. Plaques in the aortic arch (AA) and the common carotid artery (CCA) may be additional sources of embolization to stented internal carotid plaques during CAS. In this study, we aimed to investigate the relationship between these plaques and intracerebral embolization. Methods We analyzed the occurrence and composition of plaques in the AA and CCA by computed tomography angiography (CTA) in 101 consecutive cases of CAS. Cases of peri-procedural embolization were detected on diffusion-weighted imaging as lesions demonstrating diffusion restriction. We applied the χ2 and Fisher's exact tests, as well as logistic regression models. Results The occurrence of plaques in the AA and CCA was significantly related to the appearance of new diffusion-weighted imaging lesions (p = 0.013 and p = 0.004, respectively). Patients with soft plaques in the AA or CCA had a significantly higher risk of embolization than those without plaques (p = 0.012 and p = 0.006, respectively). In contrast, homogeneously calcified plaques did not pose significantly higher risks. Conclusions Soft plaques in the AA and CCA result in a substantial risk of embolization during CAS. Use of a CTA examination of the AA and the CCA in patients with carotid stenosis may help to select lower-risk patients for CAS.

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