| Atherosclerotic plaque composition assessed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. | |
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MedLine Citation:
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PMID: 20655687 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Previous studies have investigated the predictive value of clinical and morphologic parameters for distal embolization during carotid interventions. The composition of the atherosclerotic plaque, using virtual histology intravascular ultrasound (VH-IVUS) imaging obtained with an IVUS catheter that is advanced through the lesion after a filter has been placed distally, has not been evaluated as a marker for cerebral embolization. The purpose of this study was to assess the relationship between atherosclerotic plaque composition determined with VH-IVUS and the occurrence of cerebral embolization after carotid artery stenting (CAS). METHODS: During a 10-month period, 24 patients undergoing CAS procedures using a filter device for embolic protection were prospectively evaluated. All patients underwent VH-IVUS exams at the time of the intervention, transcranial Doppler (TCD) monitoring during CAS, and pre- and 24-hour postprocedural diffusion-weighted magnetic resonance imaging (DW-MRI) exams. Using VH-IVUS, plaque components were characterized as fibrotic, fibrofatty, dense calcium, and necrotic core. The frequency of Doppler-detected microembolic signals (MES) during CAS and the incidence and location of acute postprocedural embolic lesions detected with DW-MRI were assessed to determine cerebral embolization. Univariate and correlation analyses were used to assess the association between plaque composition and frequency of cerebral embolization. RESULTS: No periprocedural transient ischemic attacks, strokes, or deaths occurred within 30 days. Seventeen patients (71%) demonstrated new acute cerebral emboli in DW-MRI. Of these, all revealed ipsilateral lesions and 12 (50%) had contralateral lesions. For the entire study group, the median number of ipsilateral DW-MRI lesions was 1 (range, 0 to 3), and TCD MES counts were 227 (interquartile range, 143-315). Volumetric VH-IVUS analysis revealed that there was a trend for larger median dense calcium volume in patients with ipsilateral subclinical cerebral embolism detected with DW-MRI (33.2±24.5 mm3 vs 11.4±6.1 mm3; P=.08). Scatter plots of plaque components revealed statistically significant correlation between fibrofatty plaque volume (Spearman r=0.49; P=.016) and number of new ipsilateral lesions in DW-MRI. Degree of cerebral embolization during CAS measured with TCD correlated with plaque burden, necrotic core, fibrofatty, and fibrous volumes. CONCLUSIONS: Plaque composition, as determined by VH-IVUS, only weakly correlates with the degree of cerebral embolization after carotid stenting. Specifically, there is a trend for larger dense calcium volume in patients with distal embolization. Of note, the proportion of necrotic core, which has traditionally been considered the main component of a vulnerable or unstable plaque, is not definitely associated with subclinical cerebral embolization after CAS when a filter device for embolic protection is used. The role of VH-IVUS in evaluating plaque composition during CAS remains unestablished and warrants further investigation. |
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Authors:
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Carlos H Timaran; Eric B Rosero; Andres E Martinez; Adriana Ilarraza; J Gregory Modrall; G Patrick Clagett |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, Non-P.H.S. Date: 2010-07-23 |
Journal Detail:
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Title: Journal of vascular surgery Volume: 52 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-05 Completed Date: 2010-12-10 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1188-94 Citation Subset: IM |
Copyright Information:
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Published by Mosby, Inc. |
Affiliation:
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Division of Vascular and Endovascular Surgery, Department of Surgery, Veterans Affairs North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, TX 75390-9157, USA. carlos.timaran@utsouthwestern.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Balloon / adverse effects, instrumentation* Carotid Artery Diseases / pathology, therapy*, ultrasonography* Chi-Square Distribution Diffusion Magnetic Resonance Imaging Embolic Protection Devices Humans Intracranial Embolism / etiology*, pathology, prevention & control, ultrasonography Lipids / analysis Male Middle Aged Necrosis Predictive Value of Tests Prospective Studies Risk Assessment Risk Factors Stents* Texas Time Factors Treatment Outcome Ultrasonography, Doppler, Transcranial Ultrasonography, Interventional* |
| Chemical | |
Reg. No./Substance:
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0/Lipids |
| Comments/Corrections | |
Comment In:
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J Vasc Surg. 2010 Nov;52(5):1194-5
[PMID:
20655688
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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