The Impact Of Atherosclerotic Plaque Calcium Score On Short-term And Long-term Outcomes After Trans-carotid Artery Revascularization (tcar)
Leanne Elise Grafmuller, MD, Michael C. Stoner, MD, Doran S. Mix, MD, Adam J. Doyle, MD.
URMC, Rochester, NY, USA.
Title: The Impact of Atherosclerotic Plaque Calcium Score on Short-term and Long-Term Outcomes After Trans-Carotid Artery Revascularization (TCAR)
Objective: To quantify calcification within carotid artery plaques and assess its impact on percent residual stenosis, risk and rate of restenosis in patients undergoing TCAR for symptomatic and asymptomatic CAS at a high-volume center.
Methods: A retrospective review of prospectively collected institutional VQI data was performed to identify all patients undergoing TCAR from December 2015 to June 2021. Patient and lesion characteristics were gathered from a prospectively maintained database. Pre-operative computed tomography head and neck angiograms were analyzed to quantify calcium content within carotid artery plaques using a semi-automated workflow (Figure). Intraoperative digital subtraction angiograms were reviewed to calculate percent residual stenosis intra-operatively according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Peak systolic velocity (PSV), end diastolic velocity (EDV), and internal carotid artery/common carotid artery (ICA/CCA) ratio were extracted from outpatient carotid duplex ultrasounds at 1-, 6-, 12-months, and annually thereafter. A Spearman correlation of ICA calcium scores and percent residual stenosis was performed along with a Wilcoxon-Mann-Whitney test of statistical significance. A Friedman test was used to compare calcium score to PSV, EDV and ICA/CCA over the follow up period.
Results: Over two hundred carotid arteries were examined, with a mean follow-up of 986±508 days (range 90-2093 days). Mean balloon diameter and stent diameter were 5.33±0.91 mm and 8.86±1.08 mm, respectively. A weak association was found between calcium score and percent residual stenosis via Spearman Test (rs= 0.249, p = 0.035). A Friedman Test found no statistically significant change in the rate of restenosis with respect to calcium score over time (ICA/CCA: Χ2r = 2.12, p = 0.55). Further, a Friedman Test found no statistically significant change in the risk of restenosis with respect to calcium score over time (EDV: Χ2r = 2.7 , p = 0.44).
Conclusions: No statistically significant relationship was found between quantity of calcium contained in ICA plaques as measured by calcium score and percent residual stenosis, PSV, EDV, and ICA/CCA ratio over the available follow up period. The presence of diffusely calcified carotid plaques do not appear to affect the safety or efficacy of TCAR.
BAFigure: CT Angiogram Neck demonstrating calcium-scoring algorithm, pre- and post-image processing.
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