Carotid plaque echolucency increases the risk of stroke in carotid stenting - The Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study
Carotid plaque echolucency increases the risk of stroke in carotid stenting - The Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study
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DOI：
10.1161/01.cir.0000138103.91187.e3
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发表时间：
2004-08-10
期刊：
影响因子：
37.8
通讯作者：
Valsecchi, MG
中科院分区：
文献类型：
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作者：
Biasi, GM;Froio, A;Valsecchi, MG
背景-颈动脉支架植入术（CAS）最近成为颈动脉内膜切除术的一种潜在替代方法。脑栓塞是CAS最具破坏性的并发症，颈动脉斑块的回声被认为是其危险因素之一。这是第一个研究分析的作用，一个计算机辅助的高度可重复的回声指数，即灰度中位数（GSM），中风的风险，在CAS.Methods和结果的成像颈动脉血管成形术和中风的风险（ICAROS）注册表包括418例收集自11个国际中心的CAS。术前进行颈动脉斑块的超声评价和GSM测量。记录术中和术后神经功能缺损的发生情况。神经系统并发症的总体发生率为3.6%：轻度卒中2.2%，重度卒中1.4%。GSM ≤ 25的155例患者中有11例（7.1%）发生卒中，GSM>25的263例患者中有4例（1.5%）发生卒中（P=0.005）。重度狭窄（≥ 85%）患者卒中发生率较高（P=0.03）。脑保护装置的有效性在GSM >25的患者中得到证实（P=0.01），但在GSM小于或等于25的患者中没有证实。多变量分析显示，GSM（OR，7.11; P=0.002）和狭窄率（OR，5.76; P=0.010）是卒中的独立预测因子。结论：颈动脉斑块回声透明，如GSM小于或等于25，增加CAS卒中的风险。在颈动脉病变的任何血管内手术计划中纳入以GSM测量的回声透亮度，可以对CAS中不同并发症风险的患者进行分层。
Background-Carotid artery stenting (CAS) has recently emerged as a potential alternative to carotid endarterectomy. Cerebral embolization is the most devastating complication of CAS, and the echogenicity of carotid plaque has been indicated as one of the risk factors involved. This is the first study to analyze the role of a computer-assisted highly reproducible index of echogenicity, namely the gray-scale median (GSM), on the risk of stroke during CAS.Methods and Results-The Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) registry included 418 cases of CAS collected from 11 international centers. An echographic evaluation of carotid plaque with GSM measurement was made preprocedurally. The onset of neurological deficits during the procedure and the postprocedural period was recorded. The overall rate of neurological complications was 3.6%: minor strokes, 2.2%, and major stroke, 1.4%. There were 11 of 155 strokes (7.1%) in patients with GSM less than or equal to25 and 4 of 263 (1.5%) in patients with GSM>25 (P=0.005). Patients with severe stenosis (greater than or equal to85%) had a higher rate of stroke (P=0.03). The effectiveness of brain protection devices was confirmed in those with GSM >25 (P=0.01) but not in those with GSM less than or equal to25. Multivariate analysis revealed that GSM (OR, 7.11; P=0.002) and rate of stenosis (OR, 5.76; P=0.010) are independent predictors of stroke.Conclusions-Carotid plaque echolucency, as measured by GSMless than or equal to25, increases the risk of stroke in CAS. The inclusion of echolucency measured as GSM in the planning of any endovascular procedure of carotid lesions allows stratification of patients at different risks of complications in CAS.