BACKGROUND: Long-term effect of carotid stenting (CAS) on the stabilization of the plaque is almost unrecognized. Vascular healing and remodeling might seal the atherosclerotic plaque with neointimal hyperplasia decreasing the vulnerability. We aimed to assess long-term change in the lipid signal, stent and luminal dimensions and restenosis after CAS with the intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging. METHODS: We performed follow-up angiography and NIRS-IVUS imaging of 58 carotid stents in 52 patients. Median time from CAS to the follow-up examination was 31 months (range, 5-56). The lipid signal of the stented segment was calculated from a NIRS-derived chemogram (a spectroscopic map) as the lipid core burden index (LCBI, a dimensionless number from 0 to 1,000). Planimetric and volumetric measurements from IVUS were performed to assess change in minimal stent area (MSA), minimal luminal area (MLA), stent and luminal volume, late stent expansion and percentage in-stent restenosis (ISR) volume. RESULTS: During the follow-up period, the mean (±SD) LCBI significantly decreased from 32±56 to 17±27 (P=0.002). The mean stent volume significantly increased from 717±302 to 1,019±429 mm3 (P<0.001) with mean stent expansion 43%±24%. The mean luminal volume increased from 717±302 to 760±359 mm3 (P=0.025) due to ISR encroaching 26%±15% of the stent volume. CONCLUSIONS: Lipid signal decreased during the follow-up period suggesting stabilization of the plaque. Late stent expansion was balanced with neointimal hyperplasia. TRIAL REGISTRATION: The trial is registered under clinicaltrials.gov NCT03141580.

Department of Cardiology 2nd Faculty of Medicine Charles University University Hospital Motol Prague Czech Republic

Zobrazit více v PubMed

White CJ. Carotid artery stenting. J Am Coll Cardiol 2014;64:722-31. 10.1016/j.jacc.2014.04.069 PubMed DOI

Rosenfield K, Matsumura JS, Chaturvedi S, et al. Randomized Trial of Stent versus Surgery for Asymptomatic Carotid Stenosis. N Engl J Med 2016;374:1011-20. 10.1056/NEJMoa1515706 PubMed DOI

Brott TG, Howard G, Roubin GS, et al. Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. N Engl J Med 2016;374:1021-31. 10.1056/NEJMoa1505215 PubMed DOI PMC

Clark DJ, Lessio S, O'Donoghue M, et al. Mechanisms and predictors of carotid artery stent restenosis: a serial intravascular ultrasound study. J Am Coll Cardiol 2006;47:2390-6. 10.1016/j.jacc.2006.01.076 PubMed DOI

Gardner CM, Tan H, Hull EL, et al. Detection of lipid core coronary plaques in autopsy specimens with a novel catheter-based near-infrared spectroscopy system. JACC Cardiovasc Imaging 2008;1:638-48. 10.1016/j.jcmg.2008.06.001 PubMed DOI

Waxman S, Dixon SR, L'Allier P, et al. In vivo validation of a catheter-based near-infrared spectroscopy system for detection of lipid core coronary plaques: initial results of the SPECTACL study. JACC Cardiovasc Imaging 2009;2:858-68. 10.1016/j.jcmg.2009.05.001 PubMed DOI

Stone GW, Maehara A, Muller JE, et al. Plaque Characterization to Inform the Prediction and Prevention of Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention: The CANARY Trial (Coronary Assessment by Near-infrared of Atherosclerotic Rupture-prone Yellow). JACC Cardiovasc Interv 2015;8:927-36. 10.1016/j.jcin.2015.01.032 PubMed DOI

Madder RD, Goldstein JA, Madden SP, et al. Detection by near-infrared spectroscopy of large lipid core plaques at culprit sites in patients with acute ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 2013;6:838-46. 10.1016/j.jcin.2013.04.012 PubMed DOI

Oemrawsingh RM, Cheng JM, García-García HM, et al. Near-infrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease. J Am Coll Cardiol 2014;64:2510-8. 10.1016/j.jacc.2014.07.998 PubMed DOI

Kotsugi M, Nakagawa I, Hatakeyama K, et al. Lipid Core Plaque Distribution Using Near-infrared Spectroscopy Is Consistent with Pathological Evaluation in Carotid Artery Plaques. Neurol Med Chir (Tokyo) 2020;60:499-506. 10.2176/nmc.oa.2020-0154 PubMed DOI PMC

Štěchovský C, Hájek P, Horváth M, et al. Near-infrared spectroscopy combined with intravascular ultrasound in carotid arteries. Int J Cardiovasc Imaging 2016;32:181-8. 10.1007/s10554-015-0687-x PubMed DOI

Štěchovský C, Hájek P, Horváth M, et al. Composition of carotid artery stenosis and restenosis: A series of patients assessed with intravascular ultrasound and near-infrared spectroscopy. Int J Cardiol 2016;207:64-6. 10.1016/j.ijcard.2016.01.104 PubMed DOI

Štěchovský C, Hájek P, Horváth M, et al. Effect of stenting on the near-infrared spectroscopy-derived lipid core burden index of carotid artery plaque. EuroIntervention 2019;15:e289-96. 10.4244/EIJ-D-17-01054 PubMed DOI

Nakagawa I, Kotsugi M, Park HS, et al. Near-infrared spectroscopy carotid plaque characteristics and cerebral embolism in carotid artery stenting. EuroIntervention 2021;17:599-606. 10.4244/EIJ-D-20-01050 PubMed DOI PMC

Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001;37:1478-92. 10.1016/S0735-1097(01)01175-5 PubMed DOI

Shakur SF, Hrbac T, Alaraj A, et al. Effects of extracranial carotid stenosis on intracranial blood flow. Stroke 2014;45:3427-9. 10.1161/STROKEAHA.114.006622 PubMed DOI

Willfort-Ehringer A, Ahmadi R, Gschwandtner ME, et al. Healing of carotid stents: a prospective duplex ultrasound study. J Endovasc Ther 2003;10:636-42. 10.1177/152660280301000333 PubMed DOI

Willfort-Ehringer A, Ahmadi R, Gruber D, et al. Arterial remodeling and hemodynamics in carotid stents: a prospective duplex ultrasound study over 2 years. J Vasc Surg 2004;39:728-34. 10.1016/j.jvs.2003.12.029 PubMed DOI

Kini AS, Baber U, Kovacic JC, et al. Changes in plaque lipid content after short-term intensive versus standard statin therapy: the YELLOW trial (reduction in yellow plaque by aggressive lipid-lowering therapy). J Am Coll Cardiol 2013;62:21-9. 10.1016/j.jacc.2013.03.058 PubMed DOI

Waksman R, Di Mario C, Torguson R, et al. Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging: a prospective, cohort study. Lancet 2019;394:1629-37. 10.1016/S0140-6736(19)31794-5 PubMed DOI

Madder RD, Husaini M, Davis AT, et al. Large lipid-rich coronary plaques detected by near-infrared spectroscopy at non-stented sites in the target artery identify patients likely to experience future major adverse cardiovascular events. Eur Heart J Cardiovasc Imaging 2016;17:393-9. 10.1093/ehjci/jev340 PubMed DOI

Schuurman AS, Vroegindewey M, Kardys I, et al. Near-infrared spectroscopy-derived lipid core burden index predicts adverse cardiovascular outcome in patients with coronary artery disease during long-term follow-up. Eur Heart J 2018;39:295-302. 10.1093/eurheartj/ehx247 PubMed DOI

Kini AS, Motoyama S, Vengrenyuk Y, et al. Multimodality Intravascular Imaging to Predict Periprocedural Myocardial Infarction During Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2015;8:937-45. 10.1016/j.jcin.2015.03.016 PubMed DOI

Roleder T, Kovacic JC, Ali Z, et al. Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT. EuroIntervention 2014;10:303-11. 10.4244/EIJV10I3A53 PubMed DOI

Han RO, Schwartz RS, Kobayashi Y, et al. Comparison of self-expanding and balloon-expandable stents for the reduction of restenosis. Am J Cardiol 2001;88:253-9. 10.1016/S0002-9149(01)01636-8 PubMed DOI

Kobayashi Y, Honda Y, Christie GL, et al. Long-term vessel response to a self-expanding coronary stent: a serial volumetric intravascular ultrasound analysis from the ASSURE Trial.A Stent vs. Stent Ultrasound Remodeling Evaluation. J Am Coll Cardiol 2001;37:1329-34. 10.1016/S0735-1097(01)01162-7 PubMed DOI

Schwartz RS. Pathophysiology of restenosis: interaction of thrombosis, hyperplasia, and/or remodeling. Am J Cardiol 1998;81:14E-7E. 10.1016/S0002-9149(98)00191-X PubMed DOI

Zobrazit více v PubMed

ClinicalTrials.gov
NCT03141580