Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105339. doi: 10.1016/j.jstrokecerebrovasdis.2020.105339. Epub 2020 Oct 5.
In-stent intimal restenosis (ISR) caused by neointimal hyperplasia can develop <24 months after carotid artery stenting (CAS). The utility of plaque imaging by carotid ultrasonography (US) or magnetic resonance imaging (MRI) has been investigated for the prediction of ipsilateral stroke. We aimed to investigate whether these imaging techniques are useful for detecting carotid plaques prone to ISR.
We examined 133 patients (mean age of 72.1 ± 8.4 years old) that received CAS at a single hospital from 2014 to 2018. A pre-CAS carotid plaque evaluation was performed by carotid angiography, duplex carotid US, and black-blood carotid artery MRI (BB-MRI). The mean stenosis rate was 71.0 ± 12.3% by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) methods. Follow-up carotid angiography was performed 6 months after CAS in all patients according to a predefined protocol. ISR was defined as in-stent intimal hyperplasia more than 50% stenosed based on the NASCET criteria. The selection of the stent type was at the discretion of the treating physician. Predictors of ISR were determined by multivariate logistic regression analysis.
Follow-up angiography demonstrated ISR in 33 patients (24.8%). In 44 patients, more than two stents were deployed. Univariate logistic regression analyses demonstrated echolucent lesion, floating plaque, complete occlusive or pseudo-occlusive lesion, and closed-cell stent use as significantly associated with ISR (>50%). Multivariate logistic regression analysis demonstrated that echolucent lesion (OR 4.667, 95% CI 1.849-11.779) and closed-cell stent use (OR .378, 95% CI .148-.968) were significantly associated with ISR.
Preprocedural plaque characterization by carotid US appeared to be useful to predict ISR 6 months after CAS.
血管内支架内再狭窄（ISR）是由新生内膜增生引起的，可在颈动脉支架置入术（CAS）后 24 个月内发生。颈动脉超声（US）或磁共振成像（MRI）的斑块成像已被用于预测同侧卒中。我们旨在研究这些成像技术是否有助于检测易发生 ISR 的颈动脉斑块。
我们检查了 2014 年至 2018 年在一家医院接受 CAS 的 133 名患者（平均年龄 72.1±8.4 岁）。在 CAS 前通过颈动脉血管造影、双功能颈动脉超声和黑血颈动脉 MRI（BB-MRI）进行颈动脉斑块评估。根据北美症状性颈动脉内膜切除术试验（NASCET）方法，平均狭窄率为 71.0±12.3%。根据预定方案，所有患者在 CAS 后 6 个月进行随访颈动脉血管造影。ISR 定义为基于 NASCET 标准的支架内内膜增生超过 50%狭窄。支架类型的选择由治疗医生决定。通过多变量逻辑回归分析确定 ISR 的预测因素。
随访血管造影显示 33 名患者（24.8%）存在 ISR。44 名患者中使用了两个以上的支架。单变量逻辑回归分析表明，回声不均匀病变、漂浮斑块、完全闭塞或假性闭塞病变以及使用封闭细胞支架与 ISR 显著相关（>50%）。多变量逻辑回归分析表明，回声不均匀病变（OR 4.667，95%CI 1.849-11.779）和使用封闭细胞支架（OR.378，95%CI.148-.968）与 ISR 显著相关。
CAS 前颈动脉 US 斑块特征分析似乎有助于预测 CAS 后 6 个月的 ISR。
