Dottorato in FISIOPATOLOGIA ED IMAGING CARDIO-TORACO-VASCOLARE

Titolo della tesi: IL RUOLO DELLA DILATAZIONE INTRAPROCEDURALE DELLO STENT CAROTIDEO VALUTATA CON ANGIOGRAFIA TRIDIMENSIONALE CONE BEAM CT

Purpose The aim of this study is to analyze the role and safety of angioplasty in the carotid stenting procedure with new generation devices and brain protection systems. Materials and methods From March 2020 to March 2022, 192 patients (121 M and 71 F) with severe carotid axis stenosis were prospectively recruited. The inclusion criteria in the study were: a) asymptomatic patients with evidence on CT angiography of carotid stenosis between 70% and 99% according to the NASCET index; b) symptomatic patients with CT angiography evidence of carotid stenosis between 50% and 99% according to the NASCET index. The procedures were performed with standard technique, by 2 interventional radiologists, with at least 8 years of experience in endovascular interventional radiology. All patients underwent angioplasty after stent placement. After the procedure, a third radiologist (different from the person who performed the procedures) evaluated the Cone Beam CT scans performed before and after stent angioplasty, calculating the area of the point of ​​greatest stenosis of the lumen stent. Major and minor complications of the first 30 days after the procedure were noted. Results From an initial population of 203 patients, 192 patients (121 male, mean age 73±10 y) were finally enrolled. All 192 patients had angioplasty after stent implantation. Technical success were obtained for all the procedures performed. 3 patients had a transient ischemic attack (TIA), which regressed after a few minutes. The analysis of the values ​​of the point of maximum stenosis area before and after the angioplasty procedure showed that the difference in the area of ​​the point of maximum stenosis in patients before angioplasty and after the angioplasty procedure is absolutely significant. The data described is valid for all subtypes of plaque. So the angioplasty is necessary in all stenting procedures regardless of the nature of the stenosing plaque. Conclusion Our experience demonstrated how angioplasty after stent implantation is a completely safe procedure and how is fundamental in the adaptation of the stent to the vessel wall in order to increase vessel lift and decrease the turbulent motion of blood flow.