title: Aortic arch and common carotid artery plaques with soft components pose a substantial risk of cerebral embolization during carotid stenting.
abstract: OBJECTIVE
  A higher rate of embolization is considered a disadvantage of carotid stenting (CAS), when compared with carotid endarterectomy. Plaques in the aortic arch (AA) and the common carotid artery (CCA) may be additional sources of embolization to stented internal carotid plaques during CAS. In this study, we aimed to investigate the relationship between these plaques and intracerebral embolization.
  
  
  METHODS
  We analyzed the occurrence and composition of plaques in the AA and CCA by computed tomography angiography (CTA) in 101 consecutive cases of CAS. Cases of peri-procedural embolization were detected on diffusion-weighted imaging as lesions demonstrating diffusion restriction. We applied the χ(2) and Fisher's exact tests, as well as logistic regression models.
  
  
  RESULTS
  The occurrence of plaques in the AA and CCA was significantly related to the appearance of new diffusion-weighted imaging lesions (p = 0.013 and p = 0.004, respectively). Patients with soft plaques in the AA or CCA had a significantly higher risk of embolization than those without plaques (p = 0.012 and p = 0.006, respectively). In contrast, homogeneously calcified plaques did not pose significantly higher risks.
  
  
  CONCLUSIONS
  Soft plaques in the AA and CCA result in a substantial risk of embolization during CAS. Use of a CTA examination of the AA and the CCA in patients with carotid stenosis may help to select lower-risk patients for CAS.
authors.affiliation: Department of Radiology, Medical University Center, University of Szeged, Szeged, Hungary peterszikra70@gmail.com.
authors.forename: Péter
authors.initials: P
authors.lastname: Szikra
authors.affiliation: Department of Medical Physics and Informatics, Medical University Center, University of Szeged, Szeged, Hungary.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Boda
authors.affiliation: Department of Medical Physics and Informatics, Medical University Center, University of Szeged, Szeged, Hungary.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Rarosi
authors.affiliation: Department of Cardiology, Medical University Center, University of Szeged, Szeged, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Thury
authors.affiliation: Department of Neurosurgery, University of Szeged, Medical University Center, Szeged, Hungary.
authors.forename: Pál
authors.initials: P
authors.lastname: Barzó
authors.affiliation: Department of Neurosurgery, University of Szeged, Medical University Center, Szeged, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Németh
authors.affiliation: Department of Radiology, Medical University Center, University of Szeged, Szeged, Hungary.
authors.forename: Erika
authors.initials: E
authors.lastname: Vörös
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000473:pathology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D000072226:Computed Tomography Angiography; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D058226:Plaque, Atherosclerotic / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: Aortic arch; arterial plaque; calcified plaque; carotid artery; carotid stenosis; carotid stenting; cerebral embolism; computed tomographic angiography; diffusion-weighted imaging; embolism; risk factors; soft plaque