Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy.
Bottom Line: The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P = 0.003).Results remained significant after multivariate adjustment.No associations were found for degree of stenosis and plaque surface.
Affiliation: Stroke Research Group, UCL Institute of Neurology, London, UK; Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland.Show MeSH
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Mentions: A single, experienced investigator (L. H. B.) measured all DSA films obtained at baseline. The following parameters were assessed: Degree of stenosis was calculated according to the method used in NASCET 11. Length of stenosis was measured in two ways (Fig. 1): Length 1 was defined as the distance between the proximal and the distal shoulder of the stenotic plaque, in the projection that best elongated the stenosis 12. Length 2 was defined as the distance between the proximal and distal points where the degree of stenosis decreased to 80% of its maximum, regardless of whether definite lesion shoulders were present or not. To account for differences in scaling of DSA films, lengths 1 and 2 were expressed as a fraction of the diameter of the distal common carotid artery (CCA), which was measured. The distance between measurement of the CCA reference diameter and carotid bifurcation had to equate at least 2.5 times the CCA diameter, because previous research has shown that the diameter of the CCA stabilizes proximal to this point 13. We evaluated two definitions of length of stenosis: first, using length 1 whenever two definite lesion shoulders were present, and using length 2 if the plaque did not have two definite shoulders; and second, using always length 2. Plaque surface was classified as irregular or smooth 14. Irregular surface comprised ulceration (seen in profile as a crater extending from the lumen into a stenotic plaque, or on face view as a double density), or plaques with surface irregularity or presence of multiple small craters not classifying as ulcer niches 15.
Affiliation: Stroke Research Group, UCL Institute of Neurology, London, UK; Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland.