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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Endovascular and Interventional Neurology
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1455135

Curve-centered plaques raise the risk of peri-operative neurological and cardiovascular complications during angioplasty and stenting for severe carotid stenosis

Provisionally accepted
Chul-Hoo Kang Chul-Hoo Kang 1Jong-Kook Rhim Jong-Kook Rhim 2Hong Jun Kim Hong Jun Kim 1Jay Chol Choi Jay Chol Choi 1Joonggoo Kim Joonggoo Kim 1*
  • 1 Department of Neurology, Jeju National University Hospital, Jeju, Republic of Korea
  • 2 Department of Neurosurgery, Jeju National University Hospital, Jeju, Republic of Korea

The final, formatted version of the article will be published soon.

    Introduction: Carotid artery stenting is an alternative interventional treatment to carotid endarterectomy. However, preprocedural considerations and anatomical risk factor analyses for carotid artery stenting are currently insufficient. Therefore, we investigated the high-risk anatomical appearance of carotid artery stenting ‎from the neurointerventionist perspective to predict periprocedural complications. Materials and Methods: We retrospectively reviewed patients with carotid stenosis who underwent carotid artery stenting at a comprehensive stroke center between January 2012 and December 2021. We compared the demographic characteristics, medical history, and anatomical appearance of the stenotic segment in patients with and without complications. Results: We analyzed a total of 148 patients (64 women [43.2%]; median age, 73.0 [interquartile range, 65.5-79.0]). Complications occurred in 39 of the 148 patients, primarily minor and transient. Of baseline or procedural characteristics, a high initial National Institutes of Health Stroke Scale score (P=0.04), symptomatic stenosis (P=0.01), and curve-centered plaque of the proximal ICA (P=0.01) were significantly associated with carotid artery stenting complications in unadjusted analysis. Curve-centered plaque remained an independent risk factor for carotid artery stenting complications after adjustment (odds ratio 2.23[1.02-4.88], P=0.04). Conclusions: High-risk vascular anatomical features, such as curve-centered plaque, are associated with a high frequency of periprocedural complications of carotid artery stenting. Tailored patient selection for carotid stenosis is crucial to prevent complications. Patients with curve-centered plaque should consider alternative treatment options such as carotid endarterectomy to achieve optimal clinical results. 

    Keywords: Carotid Stenosis, Carotid Stenting, Stroke, complication, Carotid angiography

    Received: 26 Jun 2024; Accepted: 05 Sep 2024.

    Copyright: © 2024 Kang, Rhim, Kim, Choi and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Joonggoo Kim, Department of Neurology, Jeju National University Hospital, Jeju, Republic of Korea

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