• Hiroki Takai, Juniti Uemura, Yoshiki Yagita, Yukari Ogawa, Keita Kinoshita, Satoshi Hirai, Manabu Ishihara, Keijirou Hara, Hiroyuki Toi, Shunji Matsubara, Hirotake Nishimura, and Masaaki Uno.
• Departments of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan. Electronic address: greenhousesouvaioasus@yahoo.co.jp.
• J Stroke Cerebrovasc Dis. 2018 Jul 1; 27 (7): 1930-1936.

BackgroundCarotid revascularization may be considered for severe stenosis, but its use for symptomatic mild stenosis (<50%) with vulnerable plaque or ulcer remains uncertain. The characteristics of patients with symptomatic mild stenosis who underwent revascularization are reviewed.MethodsThe subjects of this study were 18 patients with symptomatic mild stenosis (<50%) on angiography from among 175 patients who underwent revascularization in our department. The plaques were evaluated by black-blood magnetic resonance imaging (BB-MRI) and ultrasonography (US) and classified into 2 types: type 1 (n = 15), a lesion with an ulcer or mobile plaque or thrombosis on angiography or US; and type 2 (n = 3), a lesion without any of the above. Fourteen patients underwent carotid endarterectomy (CEA), and 4 patients underwent carotid artery stenting.ResultsThe stenosis on angiography was 27.2% ± 10.7 (5%-41%), and the area carotid artery stenosis rate on US was 69.8 ± 14.5% (44.5%-97%). The stenosis rate of these 2 methods was not at all correlated. In type 1 plaque that underwent CEA, 10 of 11 patients had vulnerable plaque by histopathology, and 1 patient had thrombus on the plaque by operative findings. In type 2 plaque that underwent CEA, all patients had vulnerable plaque by histopathology. During the follow-up period, none of the patients had restenosis or stroke.ConclusionsThe findings of US and BB-MRI in patients with symptomatic mild stenosis (<50%) on angiography are important for determining treatment. If BB-MRI or US shows the findings of vulnerable plaque in mild stenosis, surgical treatment may be considered for these patients.Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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