Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study

• Published in: Circulation (New York, N.Y.) N.Y.), 2004-08, Vol.110 (6), p.756-762
• Main Authors: Biasi, Giorgio M, Froio, Alberto, Diethrich, Edward B, Deleo, Gaetano, Galimberti, Stefania, Mingazzini, Paolo, Nicolaides, Andrew N, Griffin, Maura, Raithel, Dieter, Reid, Donald B, Valsecchi, Maria Grazia
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - surgery; Comorbidity; Female; Follow-Up Studies; Global Health; Humans; Intracranial Embolism - epidemiology; Intracranial Embolism - etiology; Likelihood Functions; Logistic Models; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prostheses and Implants - statistics & numerical data; Registries - statistics & numerical data; Reproducibility of Results; Risk; ROC Curve; Severity of Illness Index; Single-Blind Method; Stents - statistics & numerical data; Stroke - epidemiology; Stroke - etiology; Ultrasonography
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000138103.91187.E3

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. 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 < or =25 and 4 of 263 (1.5%) in patients with GSM >25 (P=0.005). Patients with severe stenosis (> or =85%) 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 < or =25. 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. Carotid plaque echolucency, as measured by GSM < or =25, 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.