Longitudinal evaluation of tissue prolapse after carotid stenting by optical coherence tomography
Objective To assess the prevalence and type of tissue prolapse(TP)occurring after endovascular treatment(ET),investigate the association between TP types and plaque morphological characteristics before ET,and observe in-stent neointimal hyperplasia(NIH)using optical coherence tomography(OCT).Methods Patients who underwent carotid artery stenting and received pre-and post-ET OCT assessment at Jinling Hospital between July 2018 and December 2019 were collected.Baseline plaque characteristics and TP features were evaluated using OCT.The TPs were classified into two categories:smooth TP(STP)and irregular and/or high attenuated TP(I/HTP).The association between I/HTP and plaque characteristics was analyzed,while NIH feature was also summarized.Results A total of 29 patients were included in the study,of whom 23 patients(79.3％)presented with TP.Among these 23 patients,9 were classified as I/HTP and 14 were classified as STP.Compared with STP,I/HTP was more commonly observed in lipid-rich plaques(7/9 vs 2/14,P=0.007),and lesions with cap rupture(7/9 vs 4/14,P=0.036).Additionally,the longitudinal length of TP appeared to be longer in cases with I/HTP compared to those with STP[3.0(1.5,4.6)mm vs 1.1(0.7,3.2)mm,Z=1.294,P=0.201].Six patients underwent OCT follow-up for a mean duration of 6.7 months,of whom 3 patients with I/HTP showed severe heterogeneous NIH(50.1％-61.8％),while 1 patient with STP and 2 patients without TP only demonstrated mild NIH.Conclusions The study observed that I/HTP was commonly found in plaques with larger lipid core and/or cap rupture,and suggested a potential relationship between I/HTP and NIH.These preliminary findings obtained from a limited sample should be verified by prospective large-scale studies.
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