Hiroyuki Katano1, Mitsuhito Mase2, Yusuke Nishikawa2, Kazuo Yamada2. 1. Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Medical Informatics and Integrative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: katano@med.nagoya-cu.ac.jp. 2. Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Abstract
BACKGROUND: The aim of this study was to clarify both the present status of treatment for carotid stenosis with highly calcified plaques and the appropriate treatment. METHODS: A total of 140 consecutive treatments for carotid stenoses (carotid endarterectomy [CEA]:carotid artery stenting [CAS] 81:59) were enrolled in the study. We classified the patients into low-calcified plaque (LCP) and high-calcified plaque (HCP) groups by calcium score, determined by a receiver operating characteristic analysis, and we compared the results after both treatments. RESULTS: The mean degree of residual stenosis and improvement rates of the stenosis after CAS for the HCP group were 9.7% ± 13.3% and 87.0% ± 16.8%, respectively, whereas those for the LCP group were 1.7% ± 6.1% and 97.9% ± 7.9% (both P < .001). A multiple logistic regression analysis revealed that only the calcium score was an independent pre-CAS predictor of residual stenosis. Restenosis at 6 months was observed frequently in the HCP group after both CAS and CEA (18.8% and 20.0%, respectively). Cerebral hyperperfusion syndrome was observed in 2 cases of CAS, 1 for each plaque group. The 30-day and 6-month rates for any stroke or death after CAS were 2.3% and 12.5% for the LCP and HCP groups, respectively, whereas those after CEA were 1.6% and 0%. CONCLUSIONS: Carotid stenoses with HCP (calcium score ≥420) treated by CAS showed a disadvantage in the degree of stent expansion compared to carotid stenoses with LCP, suggesting that CEA may be recommended as a surgical option.
BACKGROUND: The aim of this study was to clarify both the present status of treatment for carotid stenosis with highly calcified plaques and the appropriate treatment. METHODS: A total of 140 consecutive treatments for carotid stenoses (carotid endarterectomy [CEA]:carotid artery stenting [CAS] 81:59) were enrolled in the study. We classified the patients into low-calcified plaque (LCP) and high-calcified plaque (HCP) groups by calcium score, determined by a receiver operating characteristic analysis, and we compared the results after both treatments. RESULTS: The mean degree of residual stenosis and improvement rates of the stenosis after CAS for the HCP group were 9.7% ± 13.3% and 87.0% ± 16.8%, respectively, whereas those for the LCP group were 1.7% ± 6.1% and 97.9% ± 7.9% (both P < .001). A multiple logistic regression analysis revealed that only the calcium score was an independent pre-CAS predictor of residual stenosis. Restenosis at 6 months was observed frequently in the HCP group after both CAS and CEA (18.8% and 20.0%, respectively). Cerebral hyperperfusion syndrome was observed in 2 cases of CAS, 1 for each plaque group. The 30-day and 6-month rates for any stroke or death after CAS were 2.3% and 12.5% for the LCP and HCP groups, respectively, whereas those after CEA were 1.6% and 0%. CONCLUSIONS: Carotid stenoses with HCP (calcium score ≥420) treated by CAS showed a disadvantage in the degree of stent expansion compared to carotid stenoses with LCP, suggesting that CEA may be recommended as a surgical option.
Authors: Francesco Stilo; Nunzio Montelione; Rosalinda Calandrelli; Marisa Distefano; Francesco Spinelli; Vincenzo Di Lazzaro; Fabio Pilato Journal: Ann Transl Med Date: 2020-10