Hiroyuki Katano1,2, Mitsuhito Mase1, Yusuke Nishikawa1, Hiroshi Yamada1, Kazuo Yamada1. 1. Department of Neurosurgery, Nagoya City University Graduate School of Med-ical Sciences, Nagoya, Japan. 2. Depart-ment of Medical informatics and Integra-tive Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Abstract
BACKGROUND: The relationship between calcification in primary plaque and restenosis after carotid endarterectomy (CEA) has been seldom investigated. OBJECTIVE: To clarify the relationship between characteristics of calcified carotid plaque and recurrent stenosis after CEA, as well as the disease's natural course. METHODS: Ninety-four plaques out of 107 consecutive CEAs were retrospectively analyzed with regard to calcification, employing calcium score as well as shape, location, and other characteristics of original plaques. CEA was performed in a standard fashion with primary closure using an internal shunt. Restenosis was assessed by direct measurement of stenosis mainly using multidetector row computed tomography (CT) angiography. RESULTS: Univariate analysis revealed that calcium score and calcification circularity score were significantly lower in more than moderate restenosis (≥50%; 422.1 ± 551.6 vs 84.2 ± 92.0, P < .001; 1.8 ± 1.3 vs 1.1 ± 0.3, P < .001, respectively). Receiver operating characteristic analysis demonstrated a calcium score of 80, which was the optimal cutoff value for restenosis over 50% (sensitivity 0.70, specificity 0.68, pseudopositive ratio 0.32, area under curve 0.71, Youden's index 0.38). Low calcium score (OR 2.88, CI 1.06-7.79, P = .04) and low calcification circularity (OR 5.72, CI 1.42-23.1, P = .01) were independent predictors for more than moderate recurrent carotid stenosis 1 year postoperatively. Cases with decreasing tendency of restenosis showed higher calcium scores than those with increasing or unchanged tendency (217.2 ± 245.3 vs 164.5 ± 155.5, P < .001). Lower calcium score cases showed lower restenosis-free survival. CONCLUSION: Carotid plaque calcification may be inversely associated with recurrent stenosis 1 year after CEA or later. Preoperative CT assessment for less calcification will benefit restenosis patients by early prediction and close follow-up.
BACKGROUND: The relationship between calcification in primary plaque and restenosis after carotid endarterectomy (CEA) has been seldom investigated. OBJECTIVE: To clarify the relationship between characteristics of calcified carotid plaque and recurrent stenosis after CEA, as well as the disease's natural course. METHODS: Ninety-four plaques out of 107 consecutive CEAs were retrospectively analyzed with regard to calcification, employing calcium score as well as shape, location, and other characteristics of original plaques. CEA was performed in a standard fashion with primary closure using an internal shunt. Restenosis was assessed by direct measurement of stenosis mainly using multidetector row computed tomography (CT) angiography. RESULTS: Univariate analysis revealed that calcium score and calcification circularity score were significantly lower in more than moderate restenosis (≥50%; 422.1 ± 551.6 vs 84.2 ± 92.0, P < .001; 1.8 ± 1.3 vs 1.1 ± 0.3, P < .001, respectively). Receiver operating characteristic analysis demonstrated a calcium score of 80, which was the optimal cutoff value for restenosis over 50% (sensitivity 0.70, specificity 0.68, pseudopositive ratio 0.32, area under curve 0.71, Youden's index 0.38). Low calcium score (OR 2.88, CI 1.06-7.79, P = .04) and low calcification circularity (OR 5.72, CI 1.42-23.1, P = .01) were independent predictors for more than moderate recurrent carotid stenosis 1 year postoperatively. Cases with decreasing tendency of restenosis showed higher calcium scores than those with increasing or unchanged tendency (217.2 ± 245.3 vs 164.5 ± 155.5, P < .001). Lower calcium score cases showed lower restenosis-free survival. CONCLUSION: Carotid plaque calcification may be inversely associated with recurrent stenosis 1 year after CEA or later. Preoperative CT assessment for less calcification will benefit restenosispatients by early prediction and close follow-up.
Authors: Mircea Catalin Cosarca; Emőke Horváth; Calin Molnar; Gyopár-Beáta Molnár; Eliza Russu; Vasile Adrian Mureșan Journal: Exp Ther Med Date: 2021-06-11 Impact factor: 2.447