Journal of Korean Neurosurgical Society

  • 제54권2호
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  • Pages.93-99
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  • 2013
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Direct Relationship between Angiographic Characteristics of Carotid Atherosclerotic Plaque and Filling Defect in the Cerebral Protection Filters : Based on the Conventional Angiography

  • Choi, Jae-Hyung (Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) ;
  • Park, Hyun-Seok (Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) ;
  • Kim, Dae-Hyun (Department of Neurology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) ;
  • Cha, Jae-Kwan (Department of Neurology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) ;
  • Huh, Jae-Taeck (Department of Neurosurgery, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University) ;
  • Kang, Myongjin (Department of Diagnostic Radiology, Busan-Ulsan Regional Cardiocerebrovascular Center, Medical Science Research Center, College of Medicine, Dong-A University)
  • 투고 : 2013.03.30
  • 심사 : 2013.08.05
  • 발행 : 2013.08.28
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초록

Objective : Neurologic complications during carotid artery stenting (CAS) are usually associated with distal embolic event. These embolic incident during CAS are highly associated with the carotid plaque instability. The current study was undertaken to identify the angiographic characteristics of carotid plaque vulnerability, which was represented as filling defect in the cerebral protection filters during CAS. Methods : A total of 107 patients underwent CAS with use of a distal protection filter. Angiographic carotid plaque surface morphology was classified as smooth, irregular, and ulcerated. To determine predictable factors of filling defect in the protection filters, 11 variables were retrospectively analyzed which might influence filling defect in the protection filters during CAS. Results : Filling defects during CAS were presented in the 33 cerebral protection filters. In multivariate analysis, angiographic ulceration [odds ratio (OR), 6.60; 95% confidence interval (CI) : 2.24, 19.4; p=0.001], higher stenosis degree (OR, 1.06; 95% CI : 1.00, 1.12; p=0.039), and coexistent thrombus (OR, 7.58; 95% CI : 1.69, 34.05; p=0.08) were highly associated with filling defect in the cerebral protection devices during CAS. Among several variables, angiographic surface ulceration was the only significant factor associated with flow stagnation during CAS (OR, 4.11; 95% CI : 1.33, 12.72; p=0.014). Conclusion : Plaque surface morphology on carotid angiography can be a highly sensitive marker of plaque instability during CAS. The independent risk factors for filling defect in the filter devices during CAS were plaque ulceration, stenosis degree, and coexistent thrombus.

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참고문헌

  1. Beach KW, Hatsukami T, Detmer PR, Primozich JF, Ferguson MS, Gordon D, et al. : Carotid artery intraplaque hemorrhage and stenotic velocity. Stroke 24 : 314-319, 1993 https://doi.org/10.1161/01.STR.24.2.314
  2. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 325 : 445-453, 1991 https://doi.org/10.1056/NEJM199108153250701
  3. Eliasziw M, Streifler JY, Fox AJ, Hachinski VC, Ferguson GG, Barnett HJ : Significance of plaque ulceration in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial. Stroke 25 : 304-308, 1994 https://doi.org/10.1161/01.STR.25.2.304
  4. Holdsworth RJ, McCollum PT, Bryce JS, Harrison DK : Symptoms, stenosis and carotid plaque morphology. Is plaque morphology relevant? Eur J Vasc Endovasc Surg 9 : 80-85, 1995 https://doi.org/10.1016/S1078-5884(05)80229-1
  5. Krapf H, Nägele T, Kastrup A, Bühring U, Grönewäller E, Skalej M, et al. : Risk factors for periprocedural complications in carotid artery stenting without filter protection : a serial diffusion-weighted MRI study. J Neurol 253 : 364-371, 2006 https://doi.org/10.1007/s00415-005-0005-y
  6. Lovett JK, Gallagher PJ, Hands LJ, Walton J, Rothwell PM : Histological correlates of carotid plaque surface morphology on lumen contrast imaging. Circulation 110 : 2190-2197, 2004 https://doi.org/10.1161/01.CIR.0000144307.82502.32
  7. Lusis AJ : Atherosclerosis. Nature 407 : 233-241, 2000 https://doi.org/10.1038/35025203
  8. Mas JL, Chatellier G, Beyssen B; EVA-3S Investigators : Carotid angioplasty and stenting with and without cerebral protection : clinical alert from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) trial. Stroke 35 : e18-e20, 2004
  9. Mathur A, Roubin GS, Iyer SS, Piamsonboon C, Liu MW, Gomez CR, et al. : Predictors of stroke complicating carotid artery stenting. Circulation 97 : 1239-1245, 1998 https://doi.org/10.1161/01.CIR.97.13.1239
  10. Mozes G, Sullivan TM, Torres-Russotto DR, Bower TC, Hoskin TL, Sampaio SM, et al. : Carotid endarterectomy in SAPPHIRE-eligible high-risk patients : implications for selecting patients for carotid angioplasty and stenting. J Vasc Surg 39 : 958-965; discussion 965-966, 2004 https://doi.org/10.1016/j.jvs.2003.12.037
  11. Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, et al. : From vulnerable plaque to vulnerable patient : a call for new definitions and risk assessment strategies : Part I. Circulation 108 : 1664-1672, 2003 https://doi.org/10.1161/01.CIR.0000087480.94275.97
  12. Ohki T, Marin ML, Lyon RT, Berdejo GL, Soundararajan K, Ohki M, et al. : Ex vivo human carotid artery bifurcation stenting : correlation of lesion characteristics with embolic potential. J Vasc Surg 27 : 463-471, 1998 https://doi.org/10.1016/S0741-5214(98)70321-0
  13. Parodi JC, La Mura R, Ferreira LM, Mendez MV, Cersósimo H, Schönholz C, et al. : Initial evaluation of carotid angioplasty and stenting with three different cerebral protection devices. J Vasc Surg 32 : 1127-1136, 2000 https://doi.org/10.1067/mva.2000.109209
  14. Rapp JH, Pan XM, Sharp FR, Shah DM, Wille GA, Velez PM, et al. : Atheroemboli to the brain : size threshold for causing acute neuronal cell death. J Vasc Surg 32 : 68-76, 2000 https://doi.org/10.1067/mva.2000.107315
  15. Sayeed S, Stanziale SF, Wholey MH, Makaroun MS : Angiographic lesion characteristics can predict adverse outcomes after carotid artery stenting. J Vasc Surg 47 : 81-87, 2008 https://doi.org/10.1016/j.jvs.2007.09.047
  16. Tübler T, Schlüter M, Dirsch O, Sievert H, Bösenberg I, Grube E, et al. : Balloon-protected carotid artery stenting : relationship of periprocedural neurological complications with the size of particulate debris. Circulation 104 : 2791-2796, 2001 https://doi.org/10.1161/hc4801.100353
  17. Valton L, Larrue V, Arrué P, Géraud G, Bès A : Asymptomatic cerebral embolic signals in patients with carotid stenosis. Correlation with appearance of plaque ulceration on angiography. Stroke 26 : 813-815, 1995 https://doi.org/10.1161/01.STR.26.5.813
  18. van der Wal AC, Becker AE : Atherosclerotic plaque rupture--pathologic basis of plaque stability and instability. Cardiovasc Res 41 : 334-344, 1999 https://doi.org/10.1016/S0008-6363(98)00276-4
  19. Villarreal J, Silva J, Eliasziw M, Sharpe B, Fox A, Hachinski V, et al. : Trial NASCET. Prognosis of patients with intraluminal thrombus in the internal carotid artery. Stroke 29 : 276, 1998
  20. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, et al. : Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351 : 1493-1501, 2004 https://doi.org/10.1056/NEJMoa040127