Carotid Intima-Media Thickness and Plaque Morphology in Carotid Stent Patients over Time

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Introduction Carotid intima-media thickness (CIMT) is a well-known correlate of atherosclerotic disease. CIMT has not been studied in patients who have undergone carotid artery stenting. We sought to determine the effects of carotid artery stenting on common carotid artery (CCA) CIMT as well as carotid plaque morphology over time. Methods This was a retrospective chart review of 20 patients at the investigating institution. Demographic and clinical data were recorded. Gray scale B-mode images were used to perform measurements of CCA CIMT at three different locations in the stented as well as nonstented CCA by two independent observers. Mean values were calculated, and the CIMT of the stented side was compared with its control at each time point. Studies were performed preoperatively, at 1 month, 3 months, 6 months, 12 months, and 24 months postoperatively. Characterization of plaque morphology was also made at each time point. Results There were 7 female and 13 male participants. CIMT initially decreased on the stented side at 3 months but showed an increase during a 24-month period that was statistically different from the control group ( p > 0.031). Female participants demonstrated a smaller CIMT at each time point compared with male participants with a relatively stable CIMT whereas male participants demonstrated an increase in CIMT over time. A history of diabetes, smoking, statin use, or angiotensin-converting enzyme inhibitor use did not appear to affect CIMT. Characterization of carotid plaque morphology demonstrated that the majority of plaques were heterogeneous in nature and became more homogeneous after stenting. Conclusions CIMT of the CCA increases after carotid stenting. Interestingly, female participants exhibit a smaller CIMT that is not subject to change over time. The majority of plaques was heterogeneous in nature and became more stable over time. These findings lend insight into patterns of vessel wall healing after angioplasty and stenting.