• Masatomo Miura, Kiyofumi Yamada, Seigo Shindo, Kazuma Matsumoto, Kazutaka Uchida, Manabu Shirakawa, Youji Kuramoto, and Shinichi Yoshimura.
• Department of Neurosurgery, Hyogo College of Medicine, Hyogo, Japan; Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
• World Neurosurg. 2018 Nov 1; 119: 54-57.

BackgroundNeovascularization (NV) plays an important role in plaque progression and plaque vulnerability. However, visualization of NV is difficult using standard imaging tools. Recently, optical frequency domain imaging (OFDI) has provided images of intraplaque microstructure that could not be visualized by previous imaging modalities. Here we report a rare case of NV in the carotid plaque detected both before carotid artery stenting (CAS) and in an in-stent restenotic lesion using OFDI.Case DescriptionA 71-year-old man with asymptomatic severe left carotid artery stenosis was scheduled for CAS. The degree of stenosis had progressed during short-term follow-up. Preoperative magnetic resonance imaging suggested vulnerable plaque. We performed OFDI to evaluate plaque morphology before and after the CAS procedure. Before CAS, OFDI revealed multiple NVs in the carotid plaque, localized around the most stenotic lesion. After CAS, OFDI showed good apposition of the stent to the vascular wall. At 5 months after CAS, in-stent restenosis was detected, which was treated by CAS. Before CAS of the restenotic lesion, OFDI revealed multiple NVs in the restenotic lesion inside the stent struts. After stenting, no ischemic lesions were detected, and restenosis did not occur again over the 1-year follow-up period.ConclusionsIn carotid artery plaque, NV might correlate with plaque progression and in-stent restenosis. OFDI enables advanced evaluation of NVs in the carotid artery plaque.Copyright © 2018 Elsevier Inc. All rights reserved.

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