Abstract
Clinical trials regarding carotid stenosis have shown that carotid endarterectomy (CEA) reduces stroke risk in not only symptomatic but also asymptomatic individuals with moderate or severe carotid stenosis. In these clinical trials, stenosis severity was determined using 2D intra-arterial angiography. Therefore, conventional cerebral angiography is still the gold standard, although noninvasive techniques, such as helical CT angiography, duplex ultrasound, and magnetic resonance angiography, demonstrate remarkable progress.
We report two cases with moderate carotid stenosis in which stenosis grade could not be demonstrated accurately by use of conventional DSA. Compared with conventional DSA, 3D rotational angiography provided more accurate information of three-dimensional plaque structure and the relationship between the plaque and its ulcer formation in both cases. In addition, postoperative pathological examination of the plaques demonstrated that the findings of 3D rotational angiography were consistent with the actual plaque structures. In evaluation of carotid stenosis, some cases require 3D rotational angiography for adequate decision making for CEA.
