Atherosclerotic plaque characteristics and the risk of brain ischemia during internal carotid artery stenting
Authors:
F. Charvát 1; J. Vrána 1; D. Netuka 2; F. Cihlář 3; A. Krajina 4; V. Chovanec 4; R. Herzig 5; V. Procházka 6
; M. Roubec 7; P. Kešnerová 8; D. Školoudík 7; Pro Antique Trial Group 9
Authors‘ workplace:
D. Hořínek, M. Sameš, J. Neumann, M. Orlický, D. Součková, D. Ospalík, S. Vachtlová, T. Moravec, Z. Šustrová, A. Malucelli (Krajská zdravotní a. s., Ústí nad Labem)
; M. Bar, J. Havelka, T. Jonszta, T. Fadrná (FN Ostrava)
; M. Lojík, J. Raupach, Z. Bělobrádek, J. Jandura, D. Krajíčková, M. Rek, Z. Horčičiková (FN Hradec Králové)
; Radiologická klinika, Komplexní cerebrovaskulární centrum, ÚVN – VFN Praha
1; Neurochirurgická klinika, Komplexní cerebrovaskulární centrum, ÚVN – VFN Praha
2; Radiologická klinika, Komplexní cerebrovaskulární centrum, Masarykova nemocnice o. z., Krajská zdravotní a. s., FZS Univerzity J. E. Purkyně, Ústí nad Labem
3; Radiologická klinika, Komplexní cerebrovaskulární centrum, LF UK a FN Hradec Králové
4; Neurologická klinika, Komplexní cerebrovaskulární centrum, LF UK a FN Hradec Králové
5; Ústav radiodiagnostický, Komplexní cerebrovaskulární centrum, FN Ostrava
6; Neurologická klinika, Komplexní cerebrovaskulární centrum, FN Ostrava
7; Neurologická klinika, Komplexní cerebrovaskulární centrum, 2. LF UK a FN Motol, Praha
8; ANTIQUE Trial Group:T. Belšan, L. Coufalová, J. Meluzín, K. Broulíková, O. Krahula (ÚVN - VFN Praha)
9
Published in:
Cesk Slov Neurol N 2020; 83(1): 84-94
Category:
Original Paper
doi:
https://doi.org/10.14735/amcsnn202084
Overview
Aim: The aim of a prospective multicenter study was to determine whether the risk of developing a new ischemic brain lesion on control MRI is dependent on some of the characteristics of atherosclerotic plaque detected by duplex sonography, MRI and CTA.
Materials and methods: Patients with internal carotid artery stenosis (70– 95%) indicated for carotid angioplasty and stenting (CAS) were consecutively included in the prospective observational study. All enrolled patients underwent neurological and physical examinations, duplex sonographic examination of the carotid arteries with evaluation of the structure of atherosclerotic plaque in the ultrasound B-mode, CTA of the cervical and cerebral arteries and MRI of the neck and brain. The univariate and multivariate logistic regression analyses were performed to identify factors affecting the risk of the onset of brain ischemia following CAS.
Results: A total of 121 patients (93 males, age 70.5 ± 7.6 years) were enrolled in the study. Within 30 days of the CAS, 4 patients suffered from stroke, 1 patient suffered from a transient ischemic attack and 1 patient died. A new ischemic lesion on control brain MRI was detected in 34 (28.1%) patients. Using univariate and multivariate logistic regression analysis, no predictor (atherosclerotic plaque characteristics, history data, CAS data) was found to influence the risk of the onset of new brain ischemia.
Conclusion: Characteristics of atherosclerotic plaque in the area of the internal carotid artery stenosis does not affect the risk of developing brain ischemia detected by brain MRI following CAS.
Keywords:
Atherosclerosis – ultrasound – stent – internal carotid artery – Stenosis – magnetic resonance imaging
Sources
1. Ferguson GG, Eliasziw M, Barr HW et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1 415 patients. Stroke 1999; 30(9): 1751– 1758. doi: 10.1161/ 01.str.30.9.1751.
2. Yavin D, Roberts DJ, Tso M et al. Carotid endarterectomy versus stenting: a meta-analysis of randomized trials. Can J Neurol Sci 2011; 38(2): 230– 235. doi: 10.1017/ s0317167100011380.
3. Economopoulos KP, Sergentanis TN, Tsivgoulis G et al. Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes. Stroke 2011; 42(3): 687– 692. doi: 10.1161/ STROKEAHA.110.606079.
4. Murad MH, Shahrour A, Shah ND et al. A systematic review and meta-analysis of randomized trials of carotid endarterectomy vs stenting. J Vasc Surg 2011; 53(3): 792– 797. doi: 10.1016/ j.jvs.2010.10.101.
5. Eckstein HH, Ringleb P, Allenberg JR et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol 2008; 7(10): 893– 902. doi: 10.1016/ S1474-4422(08)70196-0.
6. Škoda O, Herzig R, Mikulík R et al. Klinický standard pro diagnostiku a léčbu pacientů s ischemickou cévní mozkovou příhodou a s tranzitorní ischemickou atakou – verze 2016. Cesk Slov Neurol N 2016; 79/ 112(3): 351– 363. doi: 10.14735/ amcsnn2016351.
7. Brott TG, Hobson RW 2nd, Howard G et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363(1): 11– 23. doi: 10.1056/ NEJMoa0912321.
8. Flach HZ, Ouhlous M, Hendriks JM et al. Cerebral ischemia after carotid intervention. J Endovasc Ther 2004; 11(3): 251– 257. doi: 10.1583/ 03-1128.1.
9. Lacroix V, Hammer F, Astarci P et al. Ischemic cerebral lesions after carotid surgery and carotid stenting. Eur J Vasc Endovasc Surg 2007; 33(4): 430– 435. doi: 10.1016/ j.ejvs.2006.11.012.
10. Bonati LH, Jongen LM, Haller S et al. New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 2010; 9(4): 353– 362. doi: 10.1016/ S1474-4422(10)70057-0.
11. Schnaudigel S, Gröschel K, Pilgram SM et al. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 2008; 39(6): 1911– 1919. doi: 10.1161/ STROKEAHA.107.500603.
12. Kuliha M, Roubec M, Procházka V et al. Randomized clinical trial comparing neurological outcomes after carotid endarterectomy or stenting. Br J Surg 2015; 102(3): 194– 201. doi: 10.1002/ bjs.9677.
13. Školoudík D, Škoda O, Bar M et al (eds). Neurosonologie. Praha: Galén 2003: 1– 389.
14. Rothwell PM, Eliasziw M, Gutnikov SA et al. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004; 363(9413): 915– 924. doi: 10.1016/ S0140-6736(04)15785-1.
15. Kuliha M, Roubec M, Goldírová A et al. Laboratory-based markers as predictors of brain infarction during carotid stenting: a prospective study. J Atheroscler Thromb 2016; 23(7): 839– 847. doi: 10.5551/ jat.31799.
16. Naghavi M, Falk E, Hecht HS et al. From vulnerable plaque to vulnerable patient – part III: executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) task force report. Am J Cardiol 2006; 98(2A): 2H– 15H. doi: 10.1016/ j.amjcard.2006.03.002.
17. Naim C, Douziech M, Therasse E et al. Vulnerable atherosclerotic carotid plaque evaluation by ultrasound, computed tomography angiography, and magnetic resonance imaging. Can Assoc Radiol J 2014; 65(3): 275– 286. doi: 10.1016/ j.carj.2013.05.003.
18. ten Kate GL, Sijbrands EJ, Staub D et al. Noninvasive imaging of the vulnerable atherosclerotic plaque. Curr Probl Cardiol 2010; 35(11): 556– 591. doi: 10.1016/ j.cpcardiol.2010.09.002.
19. Fleg JL, Stone GW, Fayad ZA et al. Detection of high-risk atherosclerotic plaque: report of the NHLBI Working Group on current status and future directions. JACC Cardiovasc Imaging 2012; 5(9): 941– 955. doi: 10.1016/ j.jcmg.2012.07.007.
20. Tendera M, Aboyans V, Bartelink ML et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the task force on the diagnosis and treatment of peripheral artery diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32(22): 2851– 2906. doi: 10.1093/ eurheartj/ ehr211.
21. Brott TG, Halperin JL, Abbara S et al. 2011 ASA/ ACCF/ AHA/ AANN/ AANS/ ACR/ ASNR/ CNS/ SAIP/ SCAI/ SIR/ SNIS/ SVM/ SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. Stroke 2011; 42(8): e420– e463. doi: 10.1161/ STR.0b013e3182112d08.
22. von Reutern GM, Goertler MW, Bornstein NM et al. Grading carotid stenosis using ultrasonic methods. Stroke 2012; 43(3): 916– 921. doi: 10.1161/ STROKEAHA.111.636084.
23. North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. Stroke 1991; 22(6): 711– 720. doi: 10.1161/ 01.str.22.6.711.
24. Herzig R, Urbánek K, Vlachová I et al. The role of chronic alcohol intake in patients with spontaneous intracranial hemorrhage: a carbohydrate-deficient transferrin study. Cerebrovasc Dis 2003; 15(1– 2): 22– 28. doi: 10.1159/ 000067118.
25. Bendszus M, Stoll G. Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures. Lancet Neurol 2006; 5(4): 364– 372. doi: 10.1016/ S1474-4422(06)70412-4.
26. Ringleb PA, Allenberg J, Brückmann H et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 2006; 368(9543): 1239– 1247. doi: 10.1016/ S0140-6736(06)69122-8.
27. Gossetti B, Gattuso R, Irace L et al. Embolism to the brain during carotid stenting and surgery. Acta Chir Belg 2007; 107(2): 151– 154.
28. Crawley F, Stygall J, Lunn S et al. Comparison of microembolism detected by transcranial Doppler and neuropsychological sequelae of carotid surgery and percutaneous transluminal angioplasty. Stroke 2000; 31(6): 1329– 1334. doi: 10.1161/ 01.str.31.6.1329.
29. Cho SM, Deshpande A, Pasupuleti V et al. Radiographic and symptomatic brain ischemia in CEA and CAS: a systematic review and meta-analysis. Neurology 2017; 89(19): 1977– 1984. doi: 10.1212/ WNL.0000000000004626.
30. Ji A, Lv P, Dai Y et al. Associations between carotid intraplaque hemorrhage and new ipsilateral ischemic lesions after carotid artery stenting: a quantitative study with conventional multi-contrast MRI. Int J Cardiovasc Imaging 2019; 35(6): 1047– 1054. doi: 10.1007/ s10554-018-01521-5.
31. Brinjikji W, Lehman VT, Huston J 3rd et al. The association between carotid intraplaque hemorrhage and outcomes of carotid stenting: a systematic review and meta-analysis. J Neurointerv Surg 2017; 9(9): 837– 842. doi: 10.1136/ neurintsurg-2016-012593.
32. Bijuklic K, Wandler A, Hazizi F et al. The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 2012; 59(15): 1383– 1389. doi: 10.1016/ j.jacc.2011.11.035.
33. Montorsi P, Caputi L, Galli S et al. Microembolization during carotid artery stenting in patients with high-risk, lipid-rich plaque. A randomized trial of proximal versus distal cerebral protection. J Am Coll Cardiol 2011; 58(16): 1656– 1663. doi: 10.1016/ j.jacc.2011.07.015.
34. Patti G, Tomai F, Melfi R et al. Strategies of clopidogrel load and atorvastatin reload to prevent ischemic cerebral events in patients undergoing protected carotid stenting. Results of the randomized ARMYDA-9 CAROTID (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting) study. J Am Coll Cardiol 2013; 61(13): 1379– 1387. doi: 10.1016/ j.jacc.2013.01.015.
35. Pavlík O, Václavík D, Kučera D et al. Bezpečnost karotického stentingu – srovnání protekčních systémů. Cesk Slov Neurol N 2016; 79/ 112(5): 560– 565.
36. Zeleňák K, Kurča E, Zeleňáková J et al. MR vyšetrenie mozgu pred a po CAS – výskyt embolických komplikácií a ich klinické prejavy. Cesk Slov Neurol N 2008; 71/ 104 (Suppl 1): S57– S58.
37. Pasternak RC, Baughman KL, Fallon JT et al. Scanning electron microscopy after coronary transluminal angioplasty of normal canine coronary arteries. Am J Cardiol 1980; 45(3): 591– 598. doi: 10.1016/ s0002-9149(80)80009-9.
38. Grunwald IQ, Reith W, Kühn AL et al. Proximal protection with the Gore PAES can reduce DWI lesion size in high-grade stenosis during carotid stenting. EuroIntervention 2014; 10(2): 271– 276. doi: 10.4244/ EIJV10I2A45.
39. Vucković BA, Djerić MJ, Ilić TA et al. Fibrinolytic parameters, lipid status and lipoprotein(a) in ischemic stroke patients. Srp Arh Celok Lek 2010; 138 (Suppl 1): 12– 17. doi: 10.2298/ sarh10s1012v.
40. Gupta R, Vora N, Thomas A et al. Symptomatic cerebral air embolism during neuro-angiographic procedures: incidence and problem avoidance. Neurocrit Care 2007; 7(3): 241– 246. doi: 10.1007/ s12028-007-0041-9.
41. Enomoto Y, Yoshimura S. Antiplatelet therapy for carotid artery stenting. Interv Neurol 2013; 1(3– 4): 151– 163. doi: 10.1159/ 000351686.
42. Hovens MM, Snoep JD, Eikenboom JC et al. Prevalence of persistent platelet reactivity despite use of aspirin: a systematic review. Am Heart J 2007; 153(2): 175– 181. doi: 10.1016/ j.ahj.2006.10.040.
43. Mansour K, Taher AT, Musallam KM et al. Aspirin resistance. Adv Hematol 2009; 2009: 937352. doi: 10.1155/ 2009/ 937352.
44. Feher G, Feher A, Pusch G et al. Clinical importance of aspirin and clopidogrel resistance. World J Cardiol 2010; 2(7): 171– 186. doi: 10.4330/ wjc.v2.i7.171.
45. Van Der Heyden J, Van Werkum J, Hackeng CM et al. High versus standard clopidogrel loading in patients undergoing carotid artery stenting prior to cardiac surgery to assess the number of microemboli detected with transcranial Doppler: results of the randomized IMPACT trial. J Cardiovasc Surg (Torino) 2013; 54(3): 337– 347.
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