Abstract
Since distal embolism is a major complication of carotid artery stenting (CAS), pre-operative evaluation of plaque histology has become important. Though virtual histology IVUS (VH-IVUS) is a useful device for inspecting plaque morphology, evaluation of carotid plaque with VH-IVUS is controversial because it was developed for coronary arteries.
We evaluated morphology of 6 carotid plaques with VH-IVUS during carotid endarterectomy (CEA). In addition, we performed balloon angioplasty on the extracted plaque (angioplasty-mimic) and evaluated a quantity of debris and the pathology of the plaque after angioplasty-mimic. Little debris was generated by PTA from the plaque of mainly fibrous and fibro-fatty lesions. On the other hand, there was much debris from plaque of mixed lesions, consisting of calcification and a necrotic core lesion.
On pathological examination, a large amount of debris appeared to be isolated between the layer of calcified area and the necrotic core. Lesions that were classified as calcified on VH-IVUS analysis appeared to be mixed of pathology and very vulnerable.
