Which angiographic features increase the risk of CAS for atherosclerotic disease of the carotid artery?

Updated: Oct 04, 2018
  • Author: Jake F Hemingway, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

The following factors are considered to increase the risk of CAS and should be taken into account in procedural planning [15] :

  • "Soft" lipid-rich plaque identified on noninvasive imaging
  • Extensive (≥15 mm) disease
  • Preocclusive lesion
  • Circumferential heavy calcification 
  • Aortoiliac tortuosity
  • Type III aortic arch
  • Carotid lesion with more than two 90º bends within a short distance of the target lesion
  • Significant tortuosity of the distal internal carotid artery
  • Severe aortic arch atherosclerosis

In a study aimed at identifying angiographic features that would account for the difference in periprocedural stroke and death rates between CAS and CEA, the higher stroke and death rate in patients who underwent CAS was found to be associated with a longer lesion length (≥12.85 mm),  sequential lesions, or remote lesions extending beyond the bulb. [20]


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