Carotid plaque with expansive arterial remodeling is a risk factor for ischemic complication following carotid artery stenting.

Abstract

Carotid artery stenting (CAS) is associated with a higher risk of periprocedural stroke than carotid endarterectomy. For better patient selection, more accurate risk factors should be identified. The aim of this study was to determine whether expansive arterial remodeling can predict ischemic complications in patients undergoing CAS. This retrospective study included 82 patients with carotid stenosis treated by CAS. The plaque component was evaluated using MR plaque imaging before the procedure. Following the procedure, lesion assessment was performed using MRI diffusion-weighted imaging (DWI), and patients were classified as DWI positive or negative for comparison between groups. Fifteen patients were classified as DWI positive and 67 patients as DWI negative. The mean expansive remodeling rate was 1.76±0.21 in the DWI-positive group and 1.35±0.18 in the DWI-negative group (P<0.001). Receiver-operating characteristic analysis revealed that the threshold for the expansive remodeling rate separating the two groups was 1.52 (area under the curve=0.933). The positive predictive value of postoperative new DWI lesions in the high-intensity plaque associated with a high expansive remodeling rate was 64.3%, and the negative predictive value of the isointensity plaque associated with a low expansive remodeling rate was 97.8%. These values were higher than those of the plaque component alone (32.1% and 81.7%, respectively). This study revealed that expansive arterial remodeling is a strong risk predictor of ischemic complication in CAS. Expansive remodeling rate measurements are very simple and provide useful information for determining treatment strategies for patients with carotid stenosis.