Carotid artery stenting: is there a need to revise ultrasound velocity criteria?

Lal, Brajesh K.; Hobson, Robert W.; Goldstein, Jonathan; Chakhtoura, Elie; Durán, Walter N.

doi:10.1016/j.jvs.2003.10.043

Cited by 172 publications

(159 citation statements)

References 30 publications

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“…However, ultrasonography might lead to an overestimation of ISR owing to an elevated velocity measurement from an increased stiffness of the vessel by the stent rather than a stenosis. 32 We remedied this limitation by arranging computed tomography/MR angiogram in suspected cases, and definitely, DSA in symptomatic patients with ISR.…”

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confidence: 99%

Evaluation of Carotid Angioplasty and Stenting for Radiation-Induced Carotid Stenosis

Zou

Soo

et al. 2014

Stroke

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[18][19][20][21][22][23][24] In the current study, we aimed to evaluate the procedural safety, clinical, and angiographic outcome of CAS for severe (≥70%) RIS using atherosclerotic stenosis (AS) as a control.Background and Purpose-We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control. Methods-In this 6-year prospective nonrandomized study, we compared the carotid angioplasty and stenting outcome of 65 consecutive patients (84 vessels) with RIS with that of a control group of 129 consecutive patients (150 vessels) with AS. Study end points were 30-day periprocedural stroke or death, ipsilateral ischemic stroke, technical success, procedural characteristics, instent restenosis (ISR; ≥50%) and symptomatic ISR. Results-The median follow-up was 47.3 months (95% confidence interval, 26.9-61.6). Imaging assessment was available in 74 vessels (RIS) and 120 vessels (AS) in 2 years. Comparing RIS group with AS group, the rates of periprocedural stroke or death were 1.5% (1/65) versus 1.6% (2/129; P=1); ipsilateral ischemic stroke rates were 4.6% (3/65) versus 4.7% (6/129; P=1); the annual risks of ipsilateral ischemic stroke were 1.2% (3 patient/254.7 patient year) versus 1.2% (6 patient/494.2 patient year; P=0.89); technical success rates were both 100%. Stenting of common carotid artery and the use of multiple stents was more common in the RIS group (P=0 in both cases); ISR rates were 25.7% (19/74) versus 4.2% (5/120; P<0.001); symptomatic ISR rates were 6.8% (5/74) versus 0.8% (1/120; P=0.031). Conclusions-The safety, effectiveness, and technical difficulty of carotid angioplasty and stenting for RIS are comparable with that for AS although it is associated with a higher rate of ISR.

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confidence: 99%

Evaluation of Carotid Angioplasty and Stenting for Radiation-Induced Carotid Stenosis

Zou

Soo

et al. 2014

Stroke

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“…Typical postprocedural carotid duplex sonographic velocities after successful stenting have been defined. Lal et al 3 proposed a PSV threshold of 150 cm/s or higher and a PSV ratio of 2.1 or higher for detecting residual poststent stenosis of 20% or greater; Setacci et al 12 proposed using a PSV threshold of higher than 105 cm/s for detecting poststent stenosis of 30% or greater, and AbuRahma et al 14 proposed a PSV of higher than 154 cm/s to define poststent stenosis of greater than 30%. We report reference ranges for carotid duplex sonographic velocities indicative of less than 20% stenosis on completion angiography that are consistent with these previously published criteria and confirm the observation that angiographically normal stented carotid arteries may have elevated sonographic velocities compared with native carotid arteries.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Carotid duplex sonography is the standard diagnostic test used for surveillance after carotid artery revascularization procedures, including carotid endarterectomy and carotid artery stenting. Several studies have shown elevated sonographic velocities after stenting in the absence of angiographically proven restenosis, [3][4][5][6] and whereas there have been several proposed distinct velocity-based diagnostic criteria for in-stent restenosis after stenting, 3,4,[6][7][8][9][10][11][12][13][14] most velocity criteria were developed shortly after stent placement. Few studies have explored whether Doppler flow T Article includes CME test velocities within successfully stented carotid arteries vary over time, thereby necessitating separate velocity criteria depending on the time from stent placement, or whether there are identifiable factors that influence poststent velocities.…”

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confidence: 99%

Characteristics of Duplex Sonographic Parameters Over Time After Successful Carotid Artery Stenting

Kim

Sun

Kapadia

et al. 2012

Journal of Ultrasound in Medicine

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Objectives Carotid duplex sonography is the primary tool for surveillance after carotid artery stenting, but the course of sonographic velocities over time after successful stenting is unclear. The purpose of this study was to describe carotid duplex sonographic velocity parameters after successful carotid artery stenting and to determine the predictors of poststent sonographic velocities. Methods We queried institutional carotid stent and noninvasive vascular laboratory databases for internal carotid artery stents placed between January 2004 and June 2007. We included patients with stenosis of 20% or less on completion angiograms who had carotid duplex sonography within 30 days before and 7 days after stenting. The prestent peak systolic velocity (PSV), end‐diastolic velocity (EDV), internal‐to‐common carotid artery PSV ratio, contralateral internal carotid artery velocities, stent type, open‐ versus closed‐cell stent design, and days of follow‐up were tested as potential predictors of poststent velocities. Results Eighty‐two of 498 patients met inclusion criteria. The mean PSV and PSV ratio decreased from 423.6 cm/s and 7.1 before stenting to 98.5 cm/s and 1.3 after stenting (both P < .001). During a median follow‐up of 370 days, poststent velocities remained stable. All poststent velocities (PSV, EDV, and PSV ratio) were dependent on prestent ipsilateral and contralateral velocities. The poststent EDV was dependent on the type of stent. The upper range for 0% to 20% stenosis in the stented internal carotid artery was a PSV of 141 cm/s, an EDV of 42 cm/s, and a PSV ratio of 2.1 or lower. Conclusions With a median follow‐up of 1 year, the PSV and PSV ratio remained stable over time in successfully stented carotid arteries. Deviations in sonographic parameters after initial poststent carotid duplex sonography should prompt an investigation for possible in‐stent restenosis.

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“…Dupplex ultrasound is commonly used to monitor restenosis in patients following CEA. Several authors in literature begin to report their experience in the use of ultrasonography as a follow-up tool in CAS too (Lal et al, 2004).…”

Section: Intra-operative and Post-operative Ultrasoundmentioning

confidence: 99%

Ultrasound Imaging in Vascular Diseases

Fragou¹,

Karabinis²,

Daphnis³

et al. 2011

Ultrasound Imaging - Medical Applications

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Carotid artery stenting: is there a need to revise ultrasound velocity criteria?

Cited by 172 publications

References 30 publications

Evaluation of Carotid Angioplasty and Stenting for Radiation-Induced Carotid Stenosis

Evaluation of Carotid Angioplasty and Stenting for Radiation-Induced Carotid Stenosis

Characteristics of Duplex Sonographic Parameters Over Time After Successful Carotid Artery Stenting

Ultrasound Imaging in Vascular Diseases

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