Contrast-enhanced carotid ultrasonography and MRI plaque imaging to identify patients developing in-stent intimal hyperplasia after carotid artery stenting

Aim: In-stent intimal hyperplasia (ISH) observed after carotid artery stenting (CAS) may lead to in-stent restenosis. We aimed to investigate whether contrast-enhanced carotid ultrasonography (CEUS) and magnetic resonance imaging (MRI) plaque imaging prior to CAS are predictive for ISH at 6 months after CAS.Material and method: A total of 14 patients (13 men, 1 woman; mean age, 74.2 years) were prospectively enrolled. CEUS and MRI plaque imaging were performed before CAS. ISH was diagnosed by carotid angiography at 6 months after CAS. Patients were divided into two groups based on the thicknessof ISH and age, risk factors, enhancement in CEUS, MRI plaque imaging and number of replaced stents were compared between groups.Results: Carotid angiography at 6 months after CAS revealed ISH in 10 patients. Plaque enhancement on CEUS was observed in 6 patients, all of whom showed ISH. A significant association was seen between plaque enhancement on CEUS and development of ISH (χ2 test, CEUS enhancement (+) 100% vs. CEUS enhancement (-) 50% p=0.040). Carotid plaques in 12 patients were diagnosed as unstable by MRI plaque imaging. Presence of ISH was significantly associated with unstable plaque diagnosed by MRI plaque imaging (χ2 test, unstable 83% vs. stable 0%; p=0.016).Conclusion: Carotid plaque MRI and CEUS may be useful to predict ISH after CAS.

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A case in which contrast-enhanced transoral carotid ultrasonography was useful for pre- and post-procedural evaluation in carotid artery stenting

Journal of Medical Ultrasonics ◽

10.1007/s10396-016-0747-4 ◽

2016 ◽

Vol 44 (2) ◽

pp. 207-210 ◽

Cited By ~ 3

Author(s):

Yuta Hagiwara ◽

Tomohide Yoshie ◽

Takahiro Shimizu ◽

Hana Ogura ◽

Takayuki Fukano ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Ultrasonography ◽

Contrast Enhanced ◽

Procedural Evaluation

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Use of Contrast-enhanced Carotid Ultrasonography in Preoperative Assessment for Carotid Artery Stenting

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.oa.2017-0044 ◽

2018 ◽

Vol 12 (1) ◽

pp. 14-19

Author(s):

Yuta Hagiwara ◽

Tatsuro Takada ◽

Takahiro Shimizu ◽

Tomohide Yoshie ◽

Hana Ogura ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Preoperative Assessment ◽

Carotid Ultrasonography ◽

Contrast Enhanced

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Contrast-enhanced transoral carotid ultrasonography for the evaluation of plaque protrusion after carotid artery stenting

Journal of Clinical Ultrasound ◽

10.1002/jcu.22599 ◽

2018 ◽

Vol 46 (9) ◽

pp. 598-601 ◽

Cited By ~ 2

Author(s):

Yuta Hagiwara ◽

Tomohide Yoshie ◽

Takahiro Shimizu ◽

Takayuki Fukano ◽

Tatsuro Takada ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Ultrasonography ◽

Contrast Enhanced

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Carotid Duplex Velocity Criteria Revisited for the Diagnosis of Carotid In-Stent Restenosis

Vascular ◽

10.2310/6670.2007.00030 ◽

2007 ◽

Vol 15 (3) ◽

pp. 119-125 ◽

Cited By ~ 22

Author(s):

Ali F. AbuRahma ◽

Damian Maxwell ◽

Kris Eads ◽

Sarah K. Flaherty ◽

Tabitha Stutler

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Ct Angiography ◽

Carotid Arteries ◽

Internal Carotid ◽

Carotid Angiography ◽

Residual Stenosis ◽

Stent Restenosis ◽

The Mean ◽

In Stent Restenosis

Carotid percutaneous transluminal angioplasty/stenting has become an accepted treatment modality for carotid artery stenosis in high-risk patients. There has been an ongoing debate regarding which duplex ultrasound (DUS) criteria to use to determine the rate of in-stent restenosis. This prospective study revisits DUS criteria for determining the rate of in-stent restenosis. In analyzing a subset of 12 patients (pilot study) who had both completion carotid angiography and DUS within 30 days, 10 patients with normal post-stenting carotid angiography (< 30% residual stenosis) had peak systolic velocities (PSVs) of the stented internal carotid artery (ICA) of ≤ 155 cm/s and two patients with ≥ 30% residual stenosis had internal carotid artery (ICA) PSVs of > 155 cm/s. Eighty-three patients who underwent carotid stenting as part of clinical trials were analyzed. All patients underwent post-stenting carotid DUS that was done at 1 month and every 6 months thereafter. PSVs and end-diastolic velocities of the ICA and common carotid artery were recorded. Patients with PSVs of the ICA of > 140 cm/s underwent carotid computed tomographic (CT) angiography. The perioperative stroke rate was 1.2%. When the old DUS velocity criteria for nonstented carotid arteries were applied, 54% of patients had ≥ 30% restenosis (PSV of > 120 cm/s), but when our new proposed DUS velocity criteria for stented arteries were applied (PSV of > 155 cm/s), 33% had ≥ 30% restenosis at a mean follow-up of 18 months ( p = .007). The mean PSVs for patients with normal stented carotid arteries based on CT angiography, were 122 cm/s versus 243 cm/s for ≥ 30% restenosis and 113 cm/s versus 230 cm/s for ≥ 30% restenosis based on our new criteria. The mean PSVs of in-stent restenosis of 30 to < 50%, 50 to < 70%, and 70 to 99%, based on CT angiography, were 205 cm/s, 264 cm/s, and 435 cm/s, respectively. Receiver operating curve analysis demonstrated that an ICA PSV of > 155 cm/s was optimal for detecting ≥ 30% in-stent restenosis, with a sensitivity of 100%, a specificity of 90%, a positive predictive value of 74%, and a negative predictive value of 100%. The currently used carotid DUS velocity criteria overestimated the incidence of in-stent restenosis. We propose new velocity criteria for the ICA PSV of > 155 cm/s to define ≥ 30% in-stent restenosis.

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Hyperperfusion syndrome after carotid artery stenting for repeated in-stent restenosis

Nosotchu ◽

10.3995/jstroke.10915 ◽

2021 ◽

Author(s):

Rika Inano ◽

Ryohei Goda ◽

Eiji Ogino ◽

Ryosuke Nishi ◽

Masaki Maeda ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Hyperperfusion Syndrome ◽

Stent Restenosis ◽

In Stent Restenosis

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Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis

Journal of Endovascular Therapy ◽

10.1177/1526602818783505 ◽

2018 ◽

Vol 25 (4) ◽

pp. 523-533 ◽

Cited By ~ 12

Author(s):

Pavlos Texakalidis ◽

Stefanos Giannopoulos ◽

Damianos G. Kokkinidis ◽

Giuseppe Lanzino

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Stent Design ◽

Open Cell ◽

Stent Restenosis ◽

Closed Cell ◽

Ischemic Attack ◽

In Stent Restenosis

Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20, 291 patients (mean age 71.3±3.0 years; 74.6% men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40% (OR 0.42, 95% CI 0.19 to 0.92; I2=0%) and ⩾70% (OR 0.23, 95% CI 0.10 to 0.52; I2=0%) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.

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