当科のスタッフ、柏崎大奈先生の論文「頚動脈プラークにおける陽性リモデリングは頚動脈ステント時の脳虚血合併症と関連がある」が、欧州脳神経外科学会機関誌であるActa Neurochir (Wien)誌に掲載されました。頚動脈プラークの成因や病態を考える上でも、頚動脈ステント術を安全に実施する上でも興味深い知見を発信できたと考えています。
A Voyage to Depth of Neuroscience Vol. 34
Kashiwazaki D, Kuwayama N, Akioka N, Noguchi K, Kuroda S: Carotid plaque with expansive arterial remodeling is a risk factor for ischemic complication following carotid artery stenting.
Acta Neurochir (Wien). 2017 Jul;159(7):1299-1304.
BACKGROUND: Carotid artery stenting (CAS) is associated with a higher risk of periprocedural stroke than carotid endarterectomy. For better patient selection, more accurate risk factors should be identified. The aim of this study was to determine whether expansive arterial remodeling can predict ischemic complications in patients undergoing CAS.
METHODS: This retrospective study included 82 patients with carotid stenosis treated by CAS. The plaque component was evaluated using MR plaque imaging before the procedure. Following the procedure, lesion assessment was performed using MRI diffusion-weighted imaging (DWI), and patients were classified as DWI positive or negative for comparison between groups.
RESULTS: Fifteen patients were classified as DWI positive and 67 patients as DWI negative. The mean expansive remodeling rate was 1.76 ± 0.21 in the DWI-positive group and 1.35 ± 0.18 in the DWI-negative group (P < 0.001). Receiver-operating characteristic analysis revealed that the threshold for the expansive remodeling rate separating the two groups was 1.52 (area under the curve = 0.933). The positive predictive value of postoperative new DWI lesions in the high-intensity plaque associated with a high expansive remodeling rate was 64.3%, and the negative predictive value of the isointensity plaque associated with a low expansive remodeling rate was 97.8%. These values were higher than those of the plaque component alone (32.1% and 81.7%, respectively).
CONCLUSIONS: This study revealed that expansive arterial remodeling is a strong risk predictor of ischemic complication in CAS. Expansive remodeling rate measurements are very simple and provide useful information for determining treatment strategies for patients with carotid stenosis.