Efficacy of post-dilatation during carotid artery stenting for unstable plaque using closed-cell design stent evaluated by optical coherence tomography

Abstract

Background and purpose: This study aimed to use optical coherence tomography (OCT) to evaluate the efficacy of post-dilatation (PD) after stent placement for unstable plaques during carotid artery stenting (CAS) using closed-cell design stent.

Materials and methods: Twelve unstable carotid plaque lesions diagnosed by magnetic resonance imaging were evaluated by OCT during CAS. Pre-procedural minimum lumen diameter and area were 1.5 ± 0.6 mm and 2.6 ± 1.6 mm², respectively. The lesion was pre-dilated with balloon catheters (diameter 4.8 ± 0.3 mm), and closed-cell stent was deployed. PD was performed with balloon catheters of the same size as those used for pre-dilatation. Minimum lumen diameter/area and in-stent tissue prolapse volume after stent placement and after PD were calculated by 2-dimensional cross section images. The number of the stent cells showing tissue prolapse and malapposition after stent-placement and after PD were calculated by 3-dimensional analysis.

Results: Compared to after stent placement, in-stent tissue prolapse volume (0.18 ± 0.10 to 0.22 ± 0.07 mm²/slice, P < 0.01), number of stent cells with any tissue prolapse (12.7 ± 8.2 to 21.0 ± 11.8%, P < 0.001) were significantly increased after PD; stent cells with ≥ 500-µm tissue prolapse (1.6 ± 1.1 to 0.7 ± 0.8%, P < 0.01) and stent malapposition (17.4 ± 7.2 to 14.0 ± 6.3%, P < 0.01) were significantly decreased.

Conclusions: PD after carotid stent placement caused increase in in-stent tissue prolapse volume and small tissue prolapse, however, the in-stent large tissue prolapse decreased, as the in-stent tissue prolapse may have been crushed into debris.

Keywords: Carotid artery stenting; In-stent tissue prolapse; Optical coherence tomography; Post-dilatation.