London, United Kingdom 2013 11 Vascular imaging Factors associated with vulnerable plaques characterized by Virtual Histology Intravascular Ultrasound (VH-IVUS). F. Moniche1, A. Lopez-Rueda2, J.R. Gonzalez-Marcos3, I. Gutierrez4, A. Cayuela5, A. Bustamante6, A. Mayol7, A. Gil-Peralta8, A. Gonzalez9 Hospital Universitario Virgen del Rocio, Seville, SPAIN1, Hospital Universitario Virgen del Ro-cio, Seville, SPAIN2, Hospital Universitario Virgen del Rocio, Seville, SPAIN3, Hospital Universi-tario Virgen del Rocio, Seville, SPAIN4, Hospital Universitario Virgen del Rocio, Seville, SPAIN5, Hospital Universitario Virgen del Rocio, Seville, SPAIN6, Hospital Universitario Virgen del Rocio, Seville, SPAIN7, Hospital Universitario Virgen del Rocio, Seville, SPAIN8, Hospital Universitario Virgen del Rocio, Seville, SPAIN9 Introduction After stroke or TIA, early recurrence is probably due to plaque vulnerability in patients with severe carotid stenosis. A strong correlation has been found between VH IVUS plaque characterization and the histological characteristics of the carotid plaque. Our aim was to evaluate the carotid plaque us-ing VH IVUS and analyze the factors associated with the presence of vulnerable plaque in patients with severe carotid stenosis. Methods We prospectively included 141 patients with severe ICA stenosis undergoing carotid artery stenting (CAS) with cerebral protection. Before the angioplasty, culprit plaque component was evaluated by IVUS with Virtual Histology. A vulnerable plaque was defined by a thin-cap fibroatheroma and/or calcified thin-cap fibroatheroma. Baseline characteristics and vascular risk factors were analyzed. Results Of 141 patients included (84.4% men; mean age 66.9+/-9 years), 97 were symptomatic. The mean length of plaque was 15.6+/-6.8 mm, and mean diameter stenosis was 87.3%+/-9.6%. Vulnerable plaque was found in 65 patients (46.1%). The presence of diabetes and hypertension was associated with higher frequency of vulnerable plaque (58.5% vs 40.8%, p=0.03; and 87.7% vs 73.7%, p=0.03, respectively), but not dyslipidemia, smoking status or prior coronary artery disease. Also, older age increased the rate of vulnerable plaque (69.7+/-8.4 vs 64.5+/-10.1, p=0.001). Conclusion Plaque evaluation with VH IVUS is feasible in patients with severe carotid stenosis. Vulnerable plaques are found in almost half of patients who underwent to CAS. Significantly higher rate of vul-nerable plaque is seen in diabetic and hypertensive patients and its frequency increases with age. E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 263 Table 1: Composite veins score (affected hemisphere) and inter –hemispheric score difference pre-dicting poor outcomes (mRS 3 to 6) on univariate analysis (table 1): Veins mRS 3 to 6 mRS 0 to 2 OR (95%CI), p value, RR SMCV+VOT+VOL Composite score (0 to2) (n= 23) 17 (73.9%) 6 (26.1%) 7.8 (1.78 to 34.06),0.007, 2.78 SMCV+VOT+VOL Score difference (4 to 6) (n=18) 17 (94.4%) 1 (5.6%) 54.4 (5.7 to 517.6), 0.0001, 3.967 SMCV+VOT+VOL+BVR Composite score (0 to 2) (n=16) 13 (81.2%) 3 (18.8%) 6.74 (1.49 to 30.48),0.020, 2.07 SMCV+VOT+VOL+BVR Score difference (4 to 8) (n =23) 19 (82.6%) 4 (17.4%) 20.6, (3.9 to 107.7), < 0.0001, 4.406 ICV+TSV+BVR Score difference (3 to 6) (n= 12) 9 (75%) 3 (25%) 3.231 (0.714 to 14.61), 0.168,1.558 ICV + TSV Score difference (2 to 4) (n=15) 8 (53.3%) 7 (46.7%) 0.816 (0.223 to 2.992), 1.000, 0.914 Table 2: Models looking at predictors of poor outcome (mRS 3 to 6) on multinomial logistic regres-sion analysis Mo-del: Components B Exp (B) p value,95% CI 1 SMCV+ VOT+VOL+ BVR score difference 3.253 25.876 0.019, 1.725 to 388.24 NIHSS 0.337 1.401 0.032, 1.030 to 1.906 Insular cortex invol-vement 1.893 6.642 0.313, 0.168 to 263.28 ASPECTS -0.258 0.772 0.903, 0.012 to 49.956. 2 SMCV+VOT+VOL score difference 3.785 44.022 0.023, 1.702 to 1138.5 NIHSS 0.311 1.364 0.025, 1.041 to 1.788 Insular cortex invol-vement 0.805 2.237 0.641, 0.076 to 75.76 ASPECTS -0.570 0.566 0.795, 0.008 to 41.59
Karger_ESC London_2013
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