Safety and efficacy of an open-cell stent and double-balloon protection for unstable plaques: analysis of 184 consecutive carotid artery stentings

Abstract

IntroductionIn our institute, most cases of carotid artery stenosis are treated by carotid artery stenting (CAS) with an open-cell stent and double-balloon protection, even if plaques are unstable. This study was performed to examine the outcome of CAS with an open-cell stent and double-balloon protection for unstable plaques.MethodsA total of 184 CAS procedures in our institute between October 2010 and February 2018 were assessed. Ultrasonography findings of low-echo plaques, plaque ulceration, or both were defined as unstable plaques. A plaque-to-muscle ratio (PMR) of >1.8 on T1-weighted black blood imaging using spin-echo was also defined as an unstable plaque. Seventy-four unstable plaques on ultrasonography and 86 unstable plaques evaluated by PMR were included. Open-cell stents and double-balloon protection (proximal balloon protection during lesion crossing and distal balloon protection after lesion crossing) were used in all cases.ResultsOn ultrasonography, perioperative asymptomatic thromboembolization was significantly more frequent in the unstable plaque group (39/74, 52.7%) than in the stable plaque group (41/110, 37.3%, p=0.0384). Asymptomatic thromboembolization was also significantly more frequent in the PMR >1.8 group (44/86, 51.2%) than in the PMR <1.8 group (36/98, 36.7%, p=0.0489). However, symptomatic thromboembolization was rare (n=5, 2.7%), and all of these patients had minor stroke. During the 4-year follow-up, the risk of ipsilateral stroke was 0.28% and 0.27% per year in patients with symptomatic and asymptomatic lesions, respectively.ConclusionsThe outcomes of CAS with an open-cell stent and double-balloon protection are acceptable. This method is effective and safe, even if carotid artery stenosis comprises unstable plaques.

Significado Clínico do Domínio da Peptidase M20 Contendo 1 em Pacientes com Aterosclerose Carotídea

“…As placas foram divididas em estáveis e instáveis, conforme amplamente aceito na prática clínica: 1) EMI≥1,2 mm foi considerado uma placa; 2) as placas estáveis possuem gradiente-eco forte uniforme ou gradiente-eco médio; 3) as placas instáveis são moles ou ulcerativas com gradiente-eco misto ou baixo. 14 Além disso, os pacientes foram divididos em diferentes grupos de índice de massa corporal (IMC): grupo normal, com IMC<24 kg/m 2 ; grupo com sobrepeso, com 28 kg/ m 2 >IMC≥24 kg/m 2 ; e grupo obesidade, com IMC>28 kg/m 2 . 15 Também foram obtidas amostras de sangue e características médicas de 231 indivíduos saudáveis que compareceram ao exame físico de rotina, tendo a mesma distribuição de IMC dos pacientes com AC.…”