Prediction of restenosis progression after carotid artery stenting using virtual histology IVUS

Abstract

Objective: Carotid artery stenting (CAS) has emerged as an acceptable alternative treatment for patients with carotid artery stenosis. To ensure the safety of CAS, characteristics of restenotic lesions at long-term follow-up must be clearly understood. Suitability and efficacy of virtual histology intravascular ultrasound (VH-IVUS) for assessment of CAS follow-up results and restenosis after CAS were evaluated. Methods: A Volcano Eagle Eye Gold IVUS catheter and Volcano IVG3 Oracle Imaging System were used. Follow-up VH-IUVS was performed in 26 patients that had received stents of 2 different design types (open-cell stent, n=13; closed-cell stent, n=13). Results: VH-IVUS was an effective follow-up method and although invasive, yielded adequate information on the composition of restenotic tissue on color maps. Results were highly reproducible and objective, with the ratio of components in the entire lesion able to be determined quantitatively. Lesions were of a fibrotic neointimal hyperplastic nature, suggesting that their large fibro-fatty component presented an increased risk for progression to restenosis. Comparison of follow-up results in patients treated with open- and closed-cell stents showed that use of closed-cell stents resulted in a higher incidence of restenoses. Conclusion: VH-IVUS yields highly reproducible objective results. It is an effective diagnostic method that helps to predict restenotic progression by providing information on the characteristics of lesions at post-CAS follow-up. © 2008, The Japanese Society for Neuroendovascular Therapy. All rights reserved.