title: The Virtual histology In CaroTids Observational RegistrY (VICTORY) study: a European prospective registry to assess the feasibility and safety of intravascular ultrasound and virtual histology during carotid interventions.
abstract: BACKGROUND
  Carotid occlusive disease is the most common determinant of thromboembolic stroke. However, limited insights in vivo into the pathophysiology and pathology of carotid plaques are available. We designed a prospective multicenter registry to appraise the safety and feasibility of intravascular ultrasound (IVUS) and IVUS-virtual histology (IVUS-VH) imaging before and immediately after carotid stenting.
  
  
  METHODS
  Symptomatic and asymptomatic patients scheduled for carotid stenting were included. IVUS-VH pullbacks were performed before and after stenting. Angiographic, IVUS and IVUS-VH analyses were performed. The primary objective was to appraise feasibility and safety of IVUS-VH, and secondary objectives were to correlate plaque composition and plaque type derived from IVUS-VH with acute and 30-day complications.
  
  
  RESULTS
  A total of 119 patients were enrolled. IVUS-VH could be performed in all cases (100%), with additional runs after completion of the stenting procedure in 85%. Most plaques were stable by IVUS-VH, with vulnerable ones at minimum lumen area in 7%. Conversely, vulnerable plaques were significantly more common elsewhere in the internal carotid artery (ICA, 24% of patients, p<0.001). Acute and 30-day adverse events were uncommon (2 strokes, 1 transient ischemic attack), with no significant association between these and IVUS-VH features.
  
  
  CONCLUSIONS
  IVUS and IVUS-VH examinations during carotid interventions are feasible and safe, and provide important insights on qualitative and quantitative compositions of carotid plaques. Whether carotid IVUS-VH can predict clinical events remains uncertain, awaiting long-term follow-up of the VICTORY study and additional clinical trials.
authors.affiliation: Division of Cardiology, University of Tor Vergata, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sangiorgi
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.forename: Paolo
authors.initials: P
authors.lastname: Sganzerla
authors.forename: Giorgio
authors.initials: G
authors.lastname: Binetti
authors.forename: Luigi
authors.initials: L
authors.lastname: Inglese
authors.forename: Piotr
authors.initials: P
authors.lastname: Musialek
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Biasi
authors.forename: Jacek
authors.initials: J
authors.lastname: Jakala
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mauriello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D015607:Stents; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Atherosclerosis; Carotid; Intravascular ultrasound; Plaque morphology; Stent; Virtual histology