Intraplaque neovascularisation is associated with ischaemic events after carotid artery stenting: an observational prospective study

BACKGROUND: Intraplaque neovascularisation (IPN) is a component of vulnerable atherosclerotic plaque, which is a biomarker of cardiovascular events. However, the identification of patients with high probability of ischaemic events after carotid artery stenting (CAS) is mainly based on vascular risk factors. Prospective studies on the development of plaques are lacking. OBJECTIVES: The purpose of this study was to investigate whether IPN detected by contrast-enhanced ultrasound is related to the occurrence of ischaemic events after CAS. METHODS: Sixty consecutive patients receiving CAS were prospectively enrolled in our centre. The patients were evaluated using contrast-enhanced ultrasound before CAS. According to the degree of microbubble enhancement, IPN was graded from 0 to 2. Endpoint events, including ischaemic stroke and other cardiovascular events, were recorded during follow-up. Kaplan–Meier survival curves and Cox proportional-hazards models were used to evaluate the risk factors for endpoint events. At a median follow-up of 30 months, 13 patients (28.9%) experienced endpoint events. Kaplan–Meier survival curves showed that patients with grade 2 IPN had a higher risk of future ischaemic events than those with grade 0 or 1 IPN (p < 0.05). Cox proportional-hazards models showed that grade 2 IPN [adjusted hazard ratio (HR), 4.049; 95% confidence interval (CI), 1.078–15.202] was a significant predictor of endpoint events (p < 0.05). CONCLUSION: Grade 2 IPN evaluated by contrast-enhanced ultrasound has predictive value for ischaemic events in patients after CAS and may help clinicians identify high-risk patients who need close follow-up. PLAIN LANGUAGE SUMMARY: Neovascularisation and carotid artery stenting Introduction: Introduction: It is unclear whether intraplaque neovascularisation (IPN) can be used as an biomarker of high probability ischemic events after carotid artery stenting (CAS). Materials and methods: We enrolled 60 patients who underwent CAS, all of whom underwent CEUS before CAS. We recorded ischaemic events during follow-up. Cox proportional-hazards models were used to evaluate the risk factors for ischaemic events. Results: We found that grade 2 IPN was an independent predictor (hazard ratio, 4.049; 95% confidence interval, 1.078–15.202; p < 0.05) of ischaemic events in patients after CAS. Conclusion: This may help clinicians identify high-risk patients who need close follow-up.