Abstract WP139: Ulceration and Symptomatic Plaque Predict Post Procedural Plaque Protrusion Following Carotid Artery Stenting
Purpose: Plaque protrusion may cause thrombo-embolic events following carotid artery stenting (CAS). We evaluated the temporal profile and the treatment options of plaque protrusion (PLP) in our series.
Methods: In 32 consecutive cases since April 2009 to December 2011, we checked intravascular status using ultrasound (US) and CT angiography (CTA) within 1 week after CAS. For these cases, medical risk factors, procedural factors, and pre-operative CTA and plaque MRI were also evaluated.
Results: As for medical factors including hypertension, diabetes mellitus and hyperlipidemia, there were no significant effects on PLP. Effects of neurological and radiological factors on post procedural PLP are shown in table1. Symptomatic and ulcerative plaque were the risk factor of the post procedural PLP (symptomatic plaque, RR 2.33; 95% CI, 1.31-4.16; p=0.01; ulceration, RR 2.33; 95% CI, 1.31-4.16; p=0.01). High intensity of T1-black blood (BB) MRI tended to induce PLP (RR 1.62; 95% CI, 1.03-2.54; p=0.09). Pre-dilatation may reduce PLP (RR, 0.53; 95% CI, 0.21-1.34; p=0.09). All cases of PLP were treated by reinforcement of anticoagulation and/or antiplatelet therapy, and one case needed stenting following balloon angioplasty for progression of plaque protrusion in spite of medical treatments. In 8 cases of PLP, 7 cases were uneventful and 1 case had a minor stroke in the post-operative course.
Conclusions: 1. In terms of plaque characteristics, ulceration and symptomatic plaque relevant to post procedural PLP. 2. Post procedural neuroimaging studies such as CTA and US are crucial to detect plaque protrusion. 3. In case of plaque protrusion, careful managements including reinforcement of thrombotic therapy and endovascular procedures are required.
- © 2012 by American Heart Association, Inc.