Carotid artery stents on CT angiography: In vitro comparison of different stent designs and sizes using 16-, 64- and 320-row CT scanners

Lettau, M.; Kotter, Elmar; Bendszus, Martin; Hähnel, Stefan

doi:10.1016/j.neurad.2013.10.003

Cited by 7 publications

(2 citation statements)

References 31 publications

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“…The same author compared in a different study 16 carotid stents in vitro and found artificial lumen narrowing ranging from 18.8% to 59.9% with significant differences in stent type and diameter, but no significant difference for the use of 16 -, 64 - or 320-row CT scanners. 21 These were small studies, and there are no studies or reviews comparing CTA with DSA, the golden standard, in stented carotid arteries. A 2007 review compared CTA with DSA in stented coronary arteries and found a sensitivity and specificity of 85% (95% CI 78%–90%) and 97% (95% CI: 95%–98%) for 16 - to 64-detector row CT scanners, 22 which are similar when compared with CTA and DSA in unstented carotid arteries.…”

Section: Discussionmentioning

confidence: 99%

Optimal cut-off criteria for duplex ultrasound compared with computed tomography angiography for the diagnosis of restenosis in stented carotid arteries in the international carotid stenting study

Bosch

Hendrikse

Davagnanam

et al. 2016

European Stroke Journal

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Introduction: Previous studies that reported duplex-ultrasound cut-off criteria, based on blood velocity parameters, for the degree of stenosis in a stented carotid artery were either retrospective, or the reference test was carried out only when a patient was suspected of having restenosis at duplex ultrasound, which is likely to have resulted in verification bias. We performed a prospective study of diagnostic accuracy to find new blood velocity cut-offs in duplex ultrasound for in-stent restenosis. Patients and methods: Stented patients within the international carotid stenting study were eligible. Patients had a carotid computed tomography angiography in addition to routine duplex ultrasound performed at a yearly follow-up. Duplex-ultrasound bloodflow velocity parameters were compared to the degree of stenosis on computed tomography angiography. The results were analysed using receiver-operating-characteristic curves. Results: We included 103 patients in this study. On computed tomography angiography, 30 (29.1%) patients had a 30%-49% in-stent restenosis, 21 (20.4%) patients had 50%-69% in-stent restenosis and 5 (4.9%) patients a 70% in-stent restenosis. The cut-off value 50% stenosis was a peak systolic velocity of 125 cm/s (sensitivity: 63% (95% CI: 41-79), specificity: 83% (95% CI: 72-90)). Discussion: This study provides a level 2b evidence for new cut-off values for in-stent restenosis. Unfortunately, we could not say anything about severe stenosis because of the low number of severe stenosis after one year. Conclusions: The 125 cm/s cut-off value on duplex ultrasound is lower than found in previous studies and equal to unstented arteries. Duplex-ultrasound measurements made in stented carotid arteries should not be corrected for the presence of a stent when determining the degree of stenosis.

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Section: Discussionmentioning

confidence: 99%

Optimal cut-off criteria for duplex ultrasound compared with computed tomography angiography for the diagnosis of restenosis in stented carotid arteries in the international carotid stenting study

Bosch

Hendrikse

Davagnanam

et al. 2016

European Stroke Journal

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“…Although the stent material causing stent artifacts influences restenosis assessment, both CTA and MRA allow for the adequate evaluation of in-stent lumen and plaque characterization. Stent imaging with CT is afflicted by the artificial narrowing of the in-stent lumen and beam-hardening artifacts, which may hamper restenosis assessment (124). Moreover, stenosis evaluation with multi-planar reformation is exact only when the stent is in parallel and oblique orientations relative to the table axis (118,125).…”

Section: Radiological Evaluation Of Carotid Restenosismentioning

confidence: 99%

The management of carotid restenosis: a comprehensive review

Stilo¹,

Montelione²,

Calandrelli³

et al. 2020

Ann Transl Med

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Carotid artery stenosis (CS) is a major medical problem affecting approximately 10% of the general population 80 years or older and causes stroke in approximately 10% of all ischemic events. In patients with symptomatic, moderate-to-severe CS, carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS), has been used to lower the risk of stroke. In primary CS, CEA was found to be superior to best medical therapy (BMT) according to 3 large randomized controlled trials (RCT). Following CEA and CAS, restenosis remains an unsolved problem involving a large number of patients as the current treatment recommendations are not as clear as those for primary stenosis. Several studies have evaluated the risk of restenosis, reporting an incidence ranging from 5% to 22% after CEA and an in-stent restenosis (ISR) rate ranging from 2.7% to 33%. Treatment and optimal management of this disease process, however, is a matter of ongoing debate, and, given the dearth of level 1evidence for the management of these conditions, the relevant guidelines lack clarity. Moreover, the incidence rates of stroke and complications in patients with carotid stenosis are derived from studies that did not use contemporary techniques and materials.Rapidly changing guidelines, updated techniques, and materials, and modern medical treatments make actual incidence rates barely comparable to previous ones. For these reasons, RCTs are critical for determining whether these patients should be treated with more aggressive treatments additional to BMT and identifying those patients indicated for surgical or endovascular treatments. This review summarizes the current evidence and controversies concerning the risks, causes, current treatment options, and prognoses in patients with restenosis after CEA or CAS.

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Filtered back projection revisited in low-kilovolt computed tomography angiography: sharp filter kernel enhances visualization of the artery of Adamkiewicz

et al. 2018

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Carotid artery stents on CT angiography: In vitro comparison of different stent designs and sizes using 16-, 64- and 320-row CT scanners

Cited by 7 publications

References 31 publications

Optimal cut-off criteria for duplex ultrasound compared with computed tomography angiography for the diagnosis of restenosis in stented carotid arteries in the international carotid stenting study

Optimal cut-off criteria for duplex ultrasound compared with computed tomography angiography for the diagnosis of restenosis in stented carotid arteries in the international carotid stenting study

The management of carotid restenosis: a comprehensive review

Filtered back projection revisited in low-kilovolt computed tomography angiography: sharp filter kernel enhances visualization of the artery of Adamkiewicz

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