title: Ultrasonographic character of carotid plaque and postprocedural brain embolisms in carotid artery stenting and carotid endarterectomy.
abstract: OBJECTIVE
  To investigate ultrasonographic character of carotid plaques, and incidences of brain embolism in carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA).
  
  
  METHODS
  CEA (22/25 symptomatic lesions) and CAS (17/20 symptomatic lesions) between 2007 and 2010. Embolic protection devices (15 occlusion and 5 filtering devices) were used during CAS. Carotid plaques were classified into three categories (I: calcificated, II: intermediately echogenic, III: echolucent). Magnetic resonance imaging (MRI) was used to investigate brain emboli.
  
  
  RESULTS
  Ultrasonographic character of the plaques in CEA cases (I: 4%, II: 88%, III: 8%) was different from the one in CAS cases (I: 10%, II: 90%, III: 0%). The incidence of brain embolism in the CAS cases was 52.6% while 0% in the CEA cases (p = 0.00037). CAS had high incidences of brain embolism in any plaques (I: 100%, II: 43.8%). In the most recent 9 procedures of CAS using occlusion devices, averaged number of embolic lesion was 1.0 (0 post operative day; 0 POD). The number increased as 1.4 (1 POD) and 2.0 (7 POD).
  
  
  CONCLUSIONS
  CEA should be currently the first choice for most patients with a high-grade and symptomatic carotid artery stenosis.
authors.affiliation: Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Shizuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mitsuoka
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Shintani
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Furuya
authors.forename: Yoshinaga
authors.initials: Y
authors.lastname: Nakao
authors.forename: Shigeki
authors.initials: S
authors.lastname: Higashi
keywords: brain embolism; carotid angioplasty; carotid endarterectomy; carotid plaque; diffusion-weighed magnetic resonance imaging
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