Keywords:
Interventional vascular, Neuroradiology brain, Vascular, CT-Angiography, MR-Angiography, Fluoroscopy, Stents, Angioplasty, Catheters, Acute, Embolism / Thrombosis, Arteriosclerosis
Authors:
R. Gandini, E. Pampana, D. Morosetti, A. Chiaravalloti, S. Fabiano, A. Bindi, G. Loreni, G. Simonetti; Rome/IT
DOI:
10.1594/ecr2013/C-0780
Purpose
Ischemic stroke is responsible for 10% of all deaths and is the second cause of mortality worldwide; however,
stroke is the leading cause of mortality in China and Japan (1).Carotid artery stenosis represents a major risk factor for stroke and transient ischemic attack (TIA) and it can determine approximately up to 25% of strokes (2).
Histologic studies have shown differences between symptomatic and asymptomatic carotid plaques (3) and,
consequently,
carotid plaque evaluation has been focused on the identification of high risk carotid plaque patterns,
as plaque ulceration,
fibrous cap rupture or inflammation signs,
instead of mere stenosis degree examination (6,
7).
In this setting,
in vivo High Resolution Contrast-enhanced MRI has been used to provide data regarding morphology and composition of human carotid plaque,
thanks to its extensively histologically validated properties (6,
8-13).
However,
recent studies paid attention to inflammation within plaques,
which stimulates the proliferation of vasa vasorum characterized by immature,
thin-walled vessels prone to rupture and to progression to intraplaque hemorrhage and plaque rupture (14).
Therefore a plaque characterized by inflammation and neovascularization by the vasa vasorum presents higher vulnerable nature compared to plaques with only high risk morphologic characteristics (15-20).
In patients affected by a high risk carotid plaque,
the first established therapy was surgical endarterectomy,
even if carotid revascularization techniques have been undergoing a continuous less invasive evolution,
mainly due to the development of new endovascular devices.
Carotid artery stenting (CAS) has emerged as an alternative therapeutic option in patients who are considered at high surgical-risk due to co-existent medical co-morbidities or anatomical high-risk features (21-23).
In this study we retrospectively evaluated the short term safety and the intermediate term efficacy in preventing cerebrovascular accidents of CAS in patients with highly inflamed vulnerable plaques ,
acute symptoms and high surgical risk,
in order to validate the endovascular procedure as a safe and effective technique.