Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study.
BACKGROUND
Carotid artery stenting (CAS) has recently emerged as a potential alternative to carotid endarterectomy. Cerebral embolization is the most devastating complication of CAS, and the echogenicity of carotid plaque has been indicated as one of the risk factors involved. This is the first study to analyze the role of a computer-assisted highly reproducible index of echogenicity, namely the gray-scale median (GSM), on the risk of stroke during CAS.


RESULTS
The Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) registry included 418 cases of CAS collected from 11 international centers. An echographic evaluation of carotid plaque with GSM measurement was made preprocedurally. The onset of neurological deficits during the procedure and the postprocedural period was recorded. The overall rate of neurological complications was 3.6%: minor strokes, 2.2%, and major stroke, 1.4%. There were 11 of 155 strokes (7.1%) in patients with GSM < or =25 and 4 of 263 (1.5%) in patients with GSM >25 (P=0.005). Patients with severe stenosis (> or =85%) had a higher rate of stroke (P=0.03). The effectiveness of brain protection devices was confirmed in those with GSM >25 (P=0.01) but not in those with GSM < or =25. Multivariate analysis revealed that GSM (OR, 7.11; P=0.002) and rate of stenosis (OR, 5.76; P=0.010) are independent predictors of stroke.


CONCLUSIONS
Carotid plaque echolucency, as measured by GSM < or =25, increases the risk of stroke in CAS. The inclusion of echolucency measured as GSM in the planning of any endovascular procedure of carotid lesions allows stratification of patients at different risks of complications in CAS.
Biasi
Giorgio M
GM
Department of Surgical Sciences and Intensive Care, University of Milan-Bicocca, Bassini/S. Gerardo Teaching Hospital, Milan, Italy. giorgio.biasi@unimib.it
Froio
Alberto
A
Diethrich
Edward B
EB
Deleo
Gaetano
G
Galimberti
Stefania
S
Mingazzini
Paolo
P
Nicolaides
Andrew N
AN
Griffin
Maura
M
Raithel
Dieter
D
Reid
Donald B
DB
Valsecchi
Maria Grazia
MG
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D020766:Intracranial Embolism / Q000453:epidemiology* / Q000209:etiology; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D019736:Prostheses and Implants / Q000706:statistics & numerical data; D012372:ROC Curve; D012042:Registries / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012306:Risk; D012720:Severity of Illness Index; D016037:Single-Blind Method; D015607:Stents / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014463:Ultrasonography