Optical Coherence Tomography as an Adjunct During Carotid Artery Stenting for Carotid Atherosclerotic Disease.

Abstract

Carotid artery stenting (CAS) has been proven to decrease the risk of stroke in symptomatic patients with moderate/high-grade carotid stenosis; however, there is an increased periprocedural risk of stroke with CAS compared to carotid endarterectomy. The goal of this article is to report the utilization of endovascular optical coherence tomography (OCT) during CAS to aid in the identification of stent malapposition, plaque prolapse, and adjacent residual thrombus that could cause periprocedural stroke. Approval was obtained for endovascular OCT imaging in patients undergoing CAS. Images were obtained before and after stenting. Images were acquired with proximal balloon occlusion and saline to clear luminal blood during acquisition. Atotal of seven patients provided informed consent for imaging. There were no complications during image acquisition or the stenting procedure. Optical coherence tomography imaging revealed free intraluminal red thrombi, fibrous cap dissections, and thin cap fibroatheromas with underlying ulcerative plaques. Plaque herniation through stents was also demonstrated along with thrombus. Poor stent apposition was clearly visible. Optical coherence tomography image acquisition was found to be safe, effective, and to provide valuable information about plaque morphology and stent-vessel interactions. The role of perioperative anticoagulation after stenting should be re-evaluated given the new findings. Astudy comparing CAS with and without OCT with aclinical primary outcome such as ipsilateral stroke could help determine if OCT is an innovative tool to guide stenting and antithrombotic management.