Echolucent Carotid Plaques as a Feature in Patients With Acute Coronary Syndrome

Seo, Yoshihiro; Watanabe, Shigeyuki; Ishizu, Tomoko; Moriyama, Naoko; Takeyasu, Noriyuki; Maeda, Hiroshi; Ishimitsu, Toshiyuki; Aonuma, Kazutaka; Yamaguchi, Iwao

doi:10.1253/circj.70.1629

Cited by 37 publications

(25 citation statements)

References 24 publications

(22 reference statements)

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“…Third, the passage of the stent to the desired position at the lesion site is associated with plaque trauma that could result in an increased probability of embolization, mainly in patients with echolucent (vulnerable) plaques. 15,16 However, in the present study the clinically relevant embolization rate was acceptably low and, moreover, we did not have any patient experience an ischemic event associated immediately with catheter or stent passage. Fourth, theoretically, after stent deployment in a heavily calcified lesion we could fail to expand the stent by balloon dilation, which could result in problems with filter device extraction.…”

Section: Discussionmentioning

confidence: 52%

Thirty-Day Outcomes of Direct Carotid Artery Stenting With Cerebral Protection in High-Risk Patients

Veselka

Černá

Zimolová

et al. 2007

Circ J

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everal trials have shown that carotid endarterectomy is superior to medical treatment alone for the prevention of stroke in patients with significant carotid artery stenosis. [1][2][3][4][5] The SAPPHIRE trial has established carotid artery stenting (CAS) in high-surgical-risk patients as an effective alternative to carotid endarterectomy. 6 CAS after previous balloon dilation has been shown to be a safe, effective, and durable method of treatment for carotid artery disease. 2 We started carotid artery interventions in 1998 and with the exception of the treatment of in-stent restenosis, every carotid intervention implies elective stent implantation. From an initial strategy of predilation followed by stent implantation, we now perform direct carotid artery stenting (DCAS) for the vast majority of lesions.The present prospective, single-center registry was designed to evaluate the feasibility and safety of DCAS with distal protection devices in consecutive patients who were scheduled for endovascular treatment of significant carotid stenoses. A safety and feasibility evaluation of the aggressive approach in indication to endovascular therapy (and only exceptional indication to carotid endarterectomy) was another aim of our study.Circ J 2007; 71: 1468 -1472 (Received February 27, 2007 revised manuscript received April 28, 2007; accepted June 4, 2007 Background Implantation of a carotid artery stent after predilation is a standard approach in the endovascular treatment of carotid artery stenoses. Stenting without predilation may be an alternative approach in a certain subset of patients. The present prospective, single-center registry was designed to evaluate the feasibility and safety of direct carotid artery stenting (DCAS) in high-risk patients. Methods and ResultsSymptomatic patients with stenosis >50% and asymptomatic patients with stenosis >70% were eligible for enrolment. Criteria for high-risk patients included: need or history of open heart surgery, history of myocardial infarction, multivessel coronary artery disease, left ventricular dysfunction (ejection fraction ≤40%), severe pulmonary or renal disease, significant contralateral carotid disease, previous endarterectomy, and age ≥80 years. All procedures were performed using a filter protection device. Patients underwent complete clinical examination before and after DCAS and at 30-day follow-up. A total of 83 consecutive patients (45 males, 68±9 years, 33% symptomatic) underwent 100 procedures and 103 stents were deployed successfully. The technical success rate of stenting was 100%. Predilation of carotid stenosis was necessary in 1 (1%) procedure. Carotid-artery stenoses before and after DCAS were 80±9% and 7±9%, respectively. The median fluoroscopic time for DCAS was 7 min. The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, myocardial infarction) was 5% (2 minor strokes, 3 transient attacks). There was 1 (1%) minor stroke within the 30-day follow-up. Conclusion DCAS is feasible and can be performed with an accept...

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Section: Discussionmentioning

confidence: 52%

Thirty-Day Outcomes of Direct Carotid Artery Stenting With Cerebral Protection in High-Risk Patients

Veselka

Černá

Zimolová

et al. 2007

Circ J

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“…[7][8][9][10][11][12] The mechanism of plaque rupture is not entirely clear, but is thought to be a multifactorial process involving thinning and weakening of the fibrous cap by enzymes secreted by activated macrophages, and biomechanical stress as the trigger leading to plaque rupture. [13][14][15] From the point of view of structural analysis, plaque rupture is structural failure when the plaque cannot resist the hemodynamic blood pressure and shear stress exerted on it.…”

mentioning

confidence: 99%

Assessment of Carotid Plaque Vulnerability Using Structural and Geometrical Determinants

Tang

U-King-Im

et al. 2008

Circ J

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upture of atheromatous plaque in the carotid artery often leads to thrombosis and subsequent stroke. 1 This is potentially preventable by carotid revascularization techniques, and the degree of luminal stenosis is commonly used in clinical practice as an indicator for carotid endarterectomy or carotid artery angioplasty/stenting. Carotid endarterectomy has been shown to be beneficial in patients with symptomatic high-grade (70-99%) stenosis, 2,3 but it is more difficult to draw conclusions about possible benefits for patients with moderate carotid stenosis. Moreover, the debate continues about whether or not asymptomatic patients with a moderate stenosis should undergo endarterectomy, despite the findings of the recent Asymptomatic Carotid Surgery Trial (ACST). 4 Previous studies have shown that vulnerable plaque (ie, prone to rupture with thromboembolic complications) has a thin fibrous cap, a large lipid core and a high inflammatory cell burden. 5,6 Therefore, investigating plaque structure and morphology may aid in the risk stratification of patients with a moderate luminal stenosis.Although the original concept of vulnerable plaque was derived from the coronary circulation, there are compelling reasons why it also applies to the carotid circulation. [7][8][9][10][11][12] The mechanism of plaque rupture is not entirely clear, but is thought to be a multifactorial process involving thinning and weakening of the fibrous cap by enzymes secreted by activated macrophages, and biomechanical stress as the trigger leading to plaque rupture. [13][14][15] From the point of view of structural analysis, plaque rupture is structural failure when the plaque cannot resist the hemodynamic blood pressure and shear stress exerted on it. In the process of plaque rupture, an excessive concentration of stress at a weak site on the plaque surface is considered to be an important factor. [16][17][18] The mechanism of plaque rupture has been widely studied using computational simulations. 17,19,20 Hung et al used histology-based 2-dimensional (D) solid models for arterial plaque and found that a thin fibrous cap and a large lipid core are important determinants of increased plaque stress. 21 Cheng et al used a finite element model based on histology to analyze coronary lesions, and their data suggested that the concentration of circumferential tensile stress in the lesion may play an important role in plaque rupture and myocardial infarction. 17 Tang et al used an ex vivo magnetic resonance imaging (MRI)-based flow-structure interaction model to study the interaction between flow and plaque, and suggested that large cyclic stress -strain variations in the plaque under pulsatile flow pressure may lead to plaque fatigue and possible rupture. 22 Imoto et al used longitudinal structural analysis of plaque rupture and revealed that plaque shape, size and remodeling may be associated with plaque rupture. 23 We previously used a blood flow and plaque interaction model to demonstrate Assessment of Carotid Plaque Vulnerability Using Structu...

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“…Therefore, the ultrasound evaluation of carotid plaques includes two different characteristics, size and echogenicity, and both have been proved as strong predictors of cardiovascular events. [22][23][24] It is well known that echogenicity reflects different histological components, an echolucent plaque being associated with a high lipid content with relatively little fibrous tissue. 25 Based on this, a study conducted by Polak J et al revealed an increased incidence of ischemic events in patients with echolucent plaques.…”

Section: High Risk Profile Beyond Luminal Stenosis Gradingmentioning

confidence: 99%

“…Several prospective studies using this imaging tool have revealed significant differences in the composition and morphology of symptomatic and asymptomatic plaques, features beyond luminal stenosis, including the presence of calcification, a large necrotic plaque core, or a thin fibrous cap. [16][17][18][19][20][21][22][23][24][25][26][27][28] Plaques with such features are more likely to cause symptoms and seem to be predictive for future thromboembolic ischemic events. 5 Numerous prospective MRI studies based on serial examinations in individuals with moderate carotid stenosis (50-70%) have shown a strong correlation between these vulnerable plaque features and the development of subsequent ischemic neurological events.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Low-Density Carotid Plaques and the Risk of Stroke

Chițu¹,

Benedek²,

Raț³

et al. 2017

Journal of Interdisciplinary Medicine

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Ischemic stroke is the second cause of death worldwide, and at least a quarter of all ischemic strokes are associated with carotid atherosclerotic disease, the diagnosis of which relies primarily on imaging methods. Traditional risk assessment in carotid atherosclerotic disease has long been based on the measurement of stenosis severity, but there is strong evidence that only stenosis grading falls short in predicting near-future events. Moreover, numerous histopathologic studies gathered increasing evidence that plaque vulnerability depends on its composition and morphology, therefore, the new concept of "vulnerable plaque" analysis is necessary, independent of the carotid narrowing. Follow-up studies concluded that the presence of a large-lipid necrotic core and thin fibrous cap are significantly more likely to result in future ischemic events and thereby are hallmarks for unstable lesions. Under these conditions, magnetic resonance imaging (MRI) and multi-detector computed tomography (MDCT) characterization of specific plaque properties can provide additional information on ischemic stroke risk that are not provided by the simple measurement of luminal stenosis. Therefore, besides the stenosis degree, plaque morphology assessment using noninvasive methods could be useful to identify rupture-prone plaques and may be a suitable prognosis tool that will help improve risk stratification and the effectiveness of therapeutic strategies.

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Echolucent Carotid Plaques as a Feature in Patients With Acute Coronary Syndrome

Cited by 37 publications

References 24 publications

Thirty-Day Outcomes of Direct Carotid Artery Stenting With Cerebral Protection in High-Risk Patients

Thirty-Day Outcomes of Direct Carotid Artery Stenting With Cerebral Protection in High-Risk Patients

Assessment of Carotid Plaque Vulnerability Using Structural and Geometrical Determinants

Low-Density Carotid Plaques and the Risk of Stroke

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