Carotid Plaque Echolucency Predicts the Risk of Stroke in Carotid Stenting According to the Type of Brain Protection Device and the Learning Curve

Abstract

To the Editor: Dr Reiter analyzed the relationship between carotid plaque morphology and the risk of stroke after carotid artery stenting (CAS), showing that the grayscale median (GSM) is not associated with adverse outcome.1 In the ICAROS Study, we demonstrated that GSM is a predictor of stroke during CAS.2 Dr Cremonesi, with one of the biggest CAS experiences, has already demonstrated Dr Reiter’s findings. They treated patients with a GSM <25 with a proximal brain protection device not requiring the crossing of the soft lesion.3 Interestingly, they found visible debris during the procedure in 66.7% of patients, confirming the embolic potential of carotid plaques with a GSM <25. Using this brain …