78 - Retrospective Evaluation of Carotid Artery Calcium Scores on Contrast-Enhanced CT Angiography and Its Association With Restenosis and Reintervention After TCAR or TFCAS

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Poster Presenter(s)

Charles Szuchan, MD

Resident Physician
St. Luke's University Health Network, United States

Author/Co-author(s)

PL

Peter Lee, DO

PGY-3 Interventional Radiology Resident
St. Luke's University Health Network, United States
RL

Ryan Lee, BA

Student
Temple/St. Luke's School of Medicine, United States
PS

Pallav Shah, MD

Diagnostic Radiology Program Director
St. Luke's University Health Network, United States
SS

Sharvil Sheth, MD, RPVI

Division Chief, Vascular Surgery
St. Luke’s University Health Network, United States
ZL

Zhenteng Li, MD

Interventional Radiologist
St. Luke's University Health Network, United States

Purpose: Carotid Endarterectomy (CEA), Trans-Carotid Artery Revascularization (TCAR), and Transfemoral Carotid Artery Stenting (TFCAS) are established interventions for mitigating stroke risk in patients with high-grade stenosis. Despite their efficacy, adverse outcomes such as stroke, death, and lesion restenosis remain concerns. Younger age, prior endarterectomy, history of neck radiation, and high calcium burden have been identified as predictors of restenosis. This study aims to establish a reliable method for quantifying carotid artery calcium burden on Contrast Enhanced Computed Tomography Angiograms (CECTA) and analyze the relationship between calcium burden or scoring on CECTA and the incidence of high-grade restenosis or the need for reintervention.

Materials and Methods: In this retrospective analysis, patients who underwent TCAR or TFCAS at a large health network from August 2016 through September 2023 were identified. They were divided into two groups: those with significant restenosis ( >50%) on follow-up imaging or who required reintervention (restenosis group or R), and those without significant restenosis or the need for reintervention (control group or C). Preprocedural CECTAs of the head and neck were analyzed, with calcium burden quantified in volume using GE's "Color ID" tool by selecting a Hounsfield unit (HU) threshold that best separates calcium from contrast. This threshold was identified by comparing the ranges of densities between calcium and contrast on a subset of patients. Calcium volumes were measured up to 4 cm below and above the carotid bifurcation. The mean calcium volumes were then compared between the R and C groups.

Results: Preliminary data indicate that the R group (n=6) demonstrated a higher mean calcium volume (297.3 mm³, range: 44.0 – 792.3 mm³) compared to the C group (n=6, 109.3 mm³, range: 0 - 206.2 mm³).

Conclusion: The initial results indicate that higher carotid artery calcium volumes can be associated with restenosis and reintervention post-TCAR or TFCAS. If validated through further statistical analysis, these findings could lead to the development of a reproducible calcium scoring system using routinely performed CECTAs, thereby improving risk stratification and ultimately enhancing patient outcomes. With further research, our study could pave the way for tailored therapeutic approaches optimizing the effectiveness of TCAR, TFCAS, and CEA.