What have we learned from the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study?
Carotid artery stenting (CAS) is used widely to treat carotid lesions. Indication to CAS is mostly based, both in trial and in clinical practice, on the percentage of stenosis and the presence or absence of preprocedural neurologic symptoms, whereas the features of the plaque are somehow disregarded and ignored. The most severe complication of CAS is stroke, related to cerebral embolization from carotid plaque. Several studies showed that echolucent plaques generate a higher number of embolic particles following carotid stenting. Echolucency can be measured using the gray scale median, which is an objective and quantitative computer-assisted grading of the echogenicity of carotid plaques. As previously demonstrated in the ICAROS study, carotid plaque echolucency is an independent risk factor for stroke in carotid stenting. Carotid plaque echolucency is one of the parameters that should be mandatory to be considered for indication to treatment.
Biasi
Giorgio M
GM
Department of Surgical Sciences and Intensive Care, University of Milano Bicocca, Vascular Surgery Unit, Bassini/S. Gerardo Teaching Hospitals. giorgio.biasi@unimib.it
Froio
Alberto
A
Deleo
Gaetano
G
Piazzoni
Claudia
C
Camesasca
Valter
V
D000800:Angioplasty, Balloon / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000517:prevention & control; D018579:Patient Selection; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control; D014463:Ultrasonography