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. 2022 Aug;31(8):106627. doi: 10.1016/j.jstrokecerebrovasdis.2022.106627. Epub 2022 Jul 4.
In-stent restenosis (ISR) caused by in-stent intimal hyperplasia (ISH) may develop after carotid artery stenting (CAS), and often necessitates re-stenting. We investigated whether new ultrasound technique is useful for detecting carotid artery plaques prone to ISR.
Superb micro-vascular imaging (SMI) is a new color Doppler imaging technique for assessing low velocity blood flow such as neovascularization in carotid artery plaques. In this study, we attempted to identify associations between findings from carotid ultrasonography with SMI performed prior to CAS and in-stent restenosis after 6 months of CAS.
This study investigated 19 patients (18 men; mean age, 72.4 years). Preoperative plaque evaluation was performed by magnetic resonance imaging, ultrasonography, and carotid angiography. Follow up angiography was performed in all patients at 6 months after CAS. ISR was defined as ISH resulting in >50% stenosis based on European Carotid Surgery Trialists criteria. We investigated whether SMI was useful as a predictor of ISR by chi-square test.
Preoperative mean stenosis rate according to North American Symptomatic Carotid Endarterectomy Trial methods in 19 patients was 61.3%. Neovascularization was observed on SMI in 10 patients (52.6%). Carotid angiography at 6 months after CAS revealed ISR in 4 patients, all of whom had shown neovascularization on SMI. A significant association was seen between findings of neovascularization on SMI and development of ISR (p = 0.033). In predicting ISR, neovascularization findings on SMI offered 100.0% sensitivity and 60.0% specificity.
Preprocedural plaque characterization by carotid ultrasound with SMI appears useful for predicting ISR at 6 months after CAS.
颈动脉支架置入术（CAS）后，支架内内膜增生（ISR）引起的支架内再狭窄（ISR）可能会发展，通常需要再次支架置入。我们研究了新的超声技术是否有助于检测颈动脉斑块中易发生 ISR 的部位。
卓越的微血管成像（SMI）是一种新的彩色多普勒成像技术，用于评估颈动脉斑块中的新生血管等低流速血流。在这项研究中，我们试图确定 CAS 术前和术后 6 个月颈动脉 SMI 检查结果与支架内再狭窄之间的关系。
本研究纳入 19 例患者（18 例男性；平均年龄 72.4 岁）。术前通过磁共振成像、超声和颈动脉血管造影评估斑块。所有患者在 CAS 后 6 个月进行随访血管造影。ISR 定义为欧洲颈动脉手术试验者标准下的 ISH 导致≥50%狭窄。我们通过卡方检验研究了 SMI 是否可作为 ISR 的预测因子。
19 例患者根据北美症状性颈动脉内膜切除术试验方法，术前平均狭窄率为 61.3%。10 例患者（52.6%）在 SMI 上观察到新生血管。CAS 术后 6 个月，4 例患者出现 ISR，均在 SMI 上显示新生血管。SMI 上新生血管的发现与 ISR 的发生之间存在显著相关性（p=0.033）。在预测 ISR 方面，SMI 上新生血管的发现具有 100.0%的敏感性和 60.0%的特异性。
CAS 术前颈动脉超声 SMI 对预测 CAS 术后 6 个月的 ISR 有一定价值。
