Comparative evaluation of angioscopy and intravascular ultrasound for assessing plaque protrusion during carotid artery stenting procedures.

Comparative evaluation of angioscopy and intravascular ultrasound for assessing plaque protrusion during carotid artery stenting procedures.

World Neurosurg. 2019 Jan 29;:

Authors: Kondo H, Kiura Y, Sakamoto S, Okazaki T, Yamasaki F, Iida K, Tominaga A, Kurisu K

Abstract
OBJECTIVE: The evaluation of plaque protrusion after carotid artery stenting (CAS) is important for predicting periprocedural ischemic complications. Unlike intravascular ultrasound (IVUS), angioscopy allows direct visualization of the plaque. This study evaluated the utility and safety of angioscopy during CAS, comparing it with IVUS.
METHODS: The study included 13 carotid artery stenosis lesions in 11 consecutive patients (mean age, 70.5 years; 10 men) at a single center. During the CAS procedure, post-stenting plaque protrusion was evaluated with angioscopy and IVUS.
RESULTS: The mean level of internal carotid artery (ICA) stenosis was 79.2%. Eight lesions were symptomatic and five lesions were predicted to have vulnerable plaque by preprocedural magnetic resonance imaging (MRI). Carotid WALLSTENTs were placed in all cases. After stenting, angioscopy provided good visualization in all cases. Plaque protrusions were observed in one case by IVUS but in eight cases by angioscopy. Diffusion weighted imaging (DWI) showed positive lesions in three cases (23%). For two of these lesions, plaque protrusions were observed by angioscopy but not by IVUS. All the lesions associated with positive DWI findings were observed to have yellow plaque on angioscopy.
CONCLUSIONS: Angioscopy provided direct visualization of the stent lumens after stenting. Angioscopy detected more plaque protrusion than IVUS and allowed clearer observation of plaque characteristics; thus, it may be more useful than IVUS for the examination of plaque protrusion and plaque evaluation after CAS, especially for plaque identified as potentially vulnerable by preprocedural examination.

PMID: 30708079 [PubMed - as supplied by publisher]

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