Department of Neurosurgery and Neuroendovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Neurosurgery and Neuroendovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
World Neurosurg. 2019 May;125:e448-e455. doi: 10.1016/j.wneu.2019.01.102. Epub 2019 Jan 29.
Evaluation of plaque protrusion after carotid artery stenting (CAS) is important for predicting periprocedural ischemic complications. In contrast to intravascular ultrasound (IVUS), angioscopy allows direct visualization of the plaque. The aim of this study was to evaluate utility and safety of angioscopy during CAS and compare it with IVUS.
The study included 13 carotid artery stenosis lesions in 11 consecutive patients (mean age 70.5 years; 10 men) at a single center. During CAS procedure, poststenting plaque protrusion was evaluated with angioscopy and IVUS.
Mean level of internal carotid artery stenosis was 79.2%. Eight lesions were symptomatic, and 5 lesions were predicted to have vulnerable plaque by preprocedural magnetic resonance imaging. A carotid WALLSTENT was placed in all cases. After stenting, angioscopy provided good visualization in all cases. Plaque protrusions were observed in 1 case by IVUS and in 8 cases by angioscopy. Diffusion-weighted imaging showed positive lesions in 3 cases (23%). For 2 of these lesions, plaque protrusions were observed by angioscopy but not by IVUS. All lesions associated with positive diffusion-weighted imaging findings were observed to have yellow plaque on angioscopy.
Angioscopy provided direct visualization of stent lumens after CAS. Angioscopy detected more plaque protrusion than IVUS and allowed clearer observation of plaque characteristics. Angioscopy may be more useful than IVUS for examination of plaque protrusion and plaque evaluation after CAS, especially for plaque identified as potentially vulnerable by preprocedural examination.
评估颈动脉支架置入术（CAS）后的斑块突出对于预测围手术期缺血性并发症很重要。与血管内超声（IVUS）相比，血管镜检查可直接观察斑块。本研究旨在评估 CAS 期间血管镜检查的实用性和安全性，并将其与 IVUS 进行比较。
本研究纳入了 11 例连续患者的 13 个颈动脉狭窄病变（平均年龄 70.5 岁；男性 10 例），均在单中心进行。在 CAS 手术过程中，使用血管镜和 IVUS 评估支架置入后的斑块突出情况。
颈内动脉狭窄的平均水平为 79.2%。8 个病变为症状性，5 个病变在术前 MRI 预测为易损斑块。所有病例均放置了颈动脉 WALLSTENT。支架置入后，血管镜检查均能提供良好的可视化效果。IVUS 观察到 1 例斑块突出，血管镜检查观察到 8 例。扩散加权成像显示 3 例（23%）阳性病变。其中 2 例血管镜检查观察到斑块突出，但 IVUS 未见。所有与阳性扩散加权成像结果相关的病变在血管镜下均观察到黄色斑块。
血管镜检查可提供 CAS 后支架管腔的直接可视化。血管镜检查比 IVUS 检测到更多的斑块突出，并且可以更清晰地观察斑块特征。血管镜检查可能比 IVUS 更有助于检查 CAS 后斑块突出和斑块评估，特别是对于术前检查确定为潜在易损斑块的病变。
