Relation between Carotid Artery Plaques Characteristics as a Predictor of Haemodynamics Changes after Carotid Artery Stenting

Objectives: To study relationship between carotid artery plaques characteristics and haemodynamic changes after carotid stenting. Patients and Methods: This observational prospective (pilot) study included 20 patients—who underwent CAS. The study was carried out in Ain shams university hospitals—Railway hospital (ERMED) and Suez insurance hospital from December 2018 to February 2020. Inclusion criteria, Symptomatic (defined as amaurosis fugax, TIA, Minor stroke or Major stroke) stenosis > 70%. Asymptomatic stenosis > 80% (accidentally discovered during pre-operative assessment for CABG and during full assessment for irrelevant stroke). Results: Regarding to plaque character for degree of stenosis, calcification and ulceration revealed significantly higher degree of stenosis in hemodynamic events group (P = 0.024). On the other hand, that there was no statistically significant difference between the two groups as regard calcification, ulceration and lesion location. Conclusion: The study revealed that HI is a common occurrence following CAS procedures and significantly higher degree of stenosis in hemodynamic events group. Plaque shape, ulcerations hardly affect haeodynamic instability after carotid stenting.

Correlation between Carotid Plaque Characteristics without Operative Indication and Ischemic Stroke

Objective To access the correlations between characteristics of carotid plaque in MRI and ischemic stroke in patients with≤50%carotid artery stenosis.Methods A total of 43 patients with≤50%carotid artery stenosis were selected for ultrasound from September 2014 to February 2016.A further test using magnetic resonance(MR)black blood imaging examination were carried out to distinguish the anatomy of the vessel as well the composition of the atherosclerotic plaque with remarkable details.The relationship between carotid plaque characteristics in MRI and other risk factors of patients with ischemic stroke was analyzed by univariate and multivariate analysis.Results The mean follow-up time was 11.8 months.During the follow-up period,4 of the 43 individuals experienced an ipsilateral ischemic stroke.Kaplan-Meier survival analysis showed the mean ischemic stroke free survival of patients with coronary heart disease(CHD)was significantly shorter than that in patients without CHD,which were 12.1 months and 18.7 months respectively(P=0.029).The mean ischemic stroke free survival of patients with intra-plaque hemorrhage(IPH)was significantly shorter than that in patients without IPH,which were 14.3 months and 18.6 months respectively(P=0.001).COX regression analysis showed that coronary heart disease(HR=27.4;95%CI,1.6-464.3;P=0.022)and IPH(HR=18.2;95%CI,2.7-123.3;P=0.003)were independent risk factors for ischemic stroke.Conclusion For patients with carotid artery stenosis≤50%,IPH of carotid plaques and CHD are independent risk factors for ischemic stroke.