Surgical Treatment for Carotid Stenoses with Highly Calcified Plaques

• Published in: Journal of stroke and cerebrovascular diseases Vol. 23; no. 1; pp. 148 - 154
• Main Authors: Katano, Hiroyuki, MD, PhD, Mase, Mitsuhito, MD, PhD, Nishikawa, Yusuke, MD, PhD, Yamada, Kazuo, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2014
• Subjects: Aged; Angioplasty; Calcification; Calcinosis - surgery; Calcium - metabolism; Cardiovascular; carotid artery stenting; carotid endarterectomy; carotid stenosis; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Endarterectomy, Carotid - methods; Female; Graft Occlusion, Vascular; Humans; Image Processing, Computer-Assisted; Iofetamine; Japan; Logistic Models; Magnetic Resonance Imaging; Male; Multidetector Computed Tomography; Neurology; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - surgery; Radiopharmaceuticals; ROC Curve; Stents; Stroke - epidemiology; Stroke - etiology; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; carotid artery stenting; Calcification; carotid endarterectomy; carotid stenosis
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.019

Background The aim of this study was to clarify both the present status of treatment for carotid stenosis with highly calcified plaques and the appropriate treatment. Methods A total of 140 consecutive treatments for carotid stenoses (carotid endarterectomy [CEA]:carotid artery stenting [CAS] 81:59) were enrolled in the study. We classified the patients into low-calcified plaque (LCP) and high-calcified plaque (HCP) groups by calcium score, determined by a receiver operating characteristic analysis, and we compared the results after both treatments. Results The mean degree of residual stenosis and improvement rates of the stenosis after CAS for the HCP group were 9.7% ± 13.3% and 87.0% ± 16.8%, respectively, whereas those for the LCP group were 1.7% ± 6.1% and 97.9% ± 7.9% (both P < .001). A multiple logistic regression analysis revealed that only the calcium score was an independent pre-CAS predictor of residual stenosis. Restenosis at 6 months was observed frequently in the HCP group after both CAS and CEA (18.8% and 20.0%, respectively). Cerebral hyperperfusion syndrome was observed in 2 cases of CAS, 1 for each plaque group. The 30-day and 6-month rates for any stroke or death after CAS were 2.3% and 12.5% for the LCP and HCP groups, respectively, whereas those after CEA were 1.6% and 0%. Conclusions Carotid stenoses with HCP (calcium score ≥420) treated by CAS showed a disadvantage in the degree of stent expansion compared to carotid stenoses with LCP, suggesting that CEA may be recommended as a surgical option.