Factors contributing to restenosis after carotid artery stenting and the usefulness of magnetic resonance plaque imaging: A study of 308 consecutive patients.

Eur J Radiol

Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima 734-8551, Japan.

Published: September 2022

AI Article Synopsis

  • * High plaque/muscle ratios on T2-weighted imaging from black-blood magnetic resonance imaging (BB MRI) were linked to a greater likelihood of developing ISR, with a specific cutoff value identified as a strong predictive factor.
  • * The findings suggest that the plaque/muscle ratio in pre-intervention MRI could serve as a valuable tool for anticipating post-CAS ISR, improving patient risk assessment.

Article Abstract

Purpose: Carotid artery stenting (CAS) is an alternative treatment strategy to carotid endarterectomy. However, post-intervention in-stent restenosis (ISR) remains a complication. The timing, frequency, and prognostic factors of ISR are unclear. The incidence and timing of post-CAS ISR were investigated, including plaque imaging to investigate the prognostic factors.

Methods: We retrospectively investigated 308 patients diagnosed with carotid stenosis who underwent CAS between April 2008 and April 2020. The patients also underwent carotid ultrasonography (US) at 1, 3, 6, and 12 months postinterventionally and every 6 months thereafter. Contributory factors in patients with ISR were also investigated.

Results: The percentage value of ISR was 4.9% (15/308). The median time from the procedure to ISR was 7 months. The ISR rate was higher for patients with a plaque/muscle ratio of ≤ 2.30 on T2-weighted imaging (T2WI) on black-blood magnetic resonance imaging (BB MRI) (p = 0.022). A plaque/muscle ratio of ≤ 2.30 on BB MRI T2WI was identified as an independent risk factor for ISR. A comparison of the incidence of ISR and the plaque/muscle ratio level on MRI T2WI was also significant (p < 0.001). In T2WI imaging of BB MRI, the cutoff value for detecting ISR from the Plaque/Muscle ratio was 1.310 [area under the curve (AUC) = 0.935, Sensitivity = 100%, specificity = 85.2%].

Conclusions: The incidence of post-CAS ISR was 4.9%, at a median time of 7 months after stenting. Plaque/muscle ratio on T2WI in pre-intervention MRI plaque imaging may be a useful predictor of post-intervention ISR.

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http://dx.doi.org/10.1016/j.ejrad.2022.110398DOI Listing

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