Noninvasive Detection of Carotid Stenosis Following Endarterectomy

Cantelmo, Nancy L.

doi:10.1001/archsurg.1981.01380200019003

Cited by 75 publications

(11 citation statements)

References 9 publications

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“…The use of noninvasive diagnostic techniques following carotid endarterectomy has been reported by Kremen et al 9 and Cantelmo et al 10 Kremen and associates, 9 using OPG-G, observed a 9.8% incidence of recurrent stenosis following 173 endarterectomies; only 2% were symptomatic. Cantelmo et al 10 combined ultrasonic arteriography with oculoplethysmography, reporting a 12% incidence of restenosis; 62% were asymptomatic, and 25% of the stenoses were hemodynamically insignificant.…”

Section: Discussionmentioning

confidence: 92%

Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

DeGroote¹,

Lynch²,

Jamil³

et al. 1987

Stroke

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Recurrent stenosis has not been a primary consideration in the selection of patients for carotid endarterectomy. We have studied the incidence of postoperative restenosis retrospectively in 265 patients following 310 carotid endarterectomies. Two hundred fourteen patients (248 endarterectomies) were examined at 6-12 month intervals using ocular pneumopiethysmography, spectral analysis, and B-mode imaging. The absolute incidence of recurrent carotid disease was 28% (69 of 248), with a 13% (33 of 248) incidence of hemodynamically significant restenosis and a 15% (36 of 248) incidence of hemodynamically insignificant disease. Life table analysis of the data projected a 32% incidence of hemodynamically significant restenosis after 7 years and a 40% incidence of hemodynamically insignificant recurrence. These data demonstrate a progressively increasing rate of restenosis. The incidence of ipsilateral neurologic events was 8% (24 of 310); 12 occurred in association with noninvasively evident recurrent disease (12 of 69, 17%), whereas 11 occurred in noninvasively determined normal arteries (11 of 179,6%). Noninvasive follow-up was not available in 1 patient. Of the 12 events associated with recurrent disease, 5 occurred in association with hemodynamically significant restenosis (5 of 33,15%), whereas 7 occurred in association with hemodynamically insignificant disease (7 of 36,19%). Carotid endarterectomy is a durable operative procedure with 92% (286 of 310) of arteries remaining asymptomatic over the period of clinical follow-up. However, absolute and life table projections of the incidence of asymptomatic restenosis are high, and this factor should be considered in the selection of patients for carotid endarterectomy, particularly in the absence of lateralizing symptoms. (Stroke 1987; 18:1031-1036) R ecurrent stenosis following carotid endarterectomy has been described previously.'-" The .. incidence of restenosis, however, remains variable, dependent on the methods of diagnosis and the inclusion of asymptomatic as well as symptomatic recurrence. Stoney and String 1 reported a 1.9% incidence of recurrent disease based on recurrent symptoms, whereas Nicholls et al 2 and O'Donnell and Callow 3 have documented recurrence rates of 12-22% based on the results of noninvasive diagnostic techniques. The implications of these data are significant and relevant to the determination of operative indications in symptomatic and asymptomatic patients.The technologic improvements in noninvasive diagnostic methods have provided safe and practical means of following patients after carotid endarterectomy. The purpose of this report is to determine the incidence of restenosis in patients undergoing carotid endarterectomy for symptomatic and asymptomatic lesions, using oculoplethysmography and ultrasonography. Data were assessed using life table analysis for a 5-7-year period of clinical follow-up.

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Section: Discussionmentioning

confidence: 92%

Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

DeGroote¹,

Lynch²,

Jamil³

et al. 1987

Stroke

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“…Cantelmo et al 40 reported that "a high proportion" of patients with recurrent stenosis had hyperlipidemia, although this was not defined. Cossman et al 4 ' found that of seven patients with restenosis within 24 months of carotid endarterectomy, six had Type II or Type IV hyperlipoproteinemia.…”

Section: Restenosis Following Endarterectomymentioning

confidence: 99%

Relation between blood lipids, lipoproteins, and cerebrovascular atherosclerosis. A review.

Tell

Crouse

Furberg

1988

Stroke

110

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Epidemiologic studies have failed to demonstrate a consistent association between blood lipid concentrations and lipoprotein abnormalities and clinical manifestations, for example, cerebral infarction. If lipids do relate to atherosclerosis, then a possible explanation for this apparent contradiction is that risk factors for symptomatic cerebrovascular disease may not necessarily be the same as those for atherosclerosis in general, that is, the factors associated with the precipitation of the clinical event may differ from those related to the underlying process of atherosclerosis. 3Because lipids are often sampled following stroke, relations, or the lack of such, between blood lipids and stroke manifestations cannot automatically be extrap-

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“…Previous reports regarding the incidence of recurrent disease or stenosis of the ICA following endarterectomy have varied widely with values from 1 to 28 % (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). This variation not only reflects the method of diagnosis, but presumably also the expertise of the neurosurgical team.…”

Section: Discussionmentioning

confidence: 99%

Patency and flow velocity profiles in the internal carotid artery assessed by digital subtraction angiography and Doppler studies two years after endarterectomy

Russell¹,

Bakke²,

Wiberg³

et al. 2009

Acta Neurologica Scandinavica

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A follow‐up of 55 patients 2 years after a total of 60 carotid endarterec‐tomies. Fifty‐two patients who had a total of 57 endarterectomies survived the first 2 post‐operative years and were re‐examined using pulsed Doppler spectral analysis and intravenous digital subtraction angiography (IVDSA). One patient had died following a stroke and 2 after a cardiac infarction. The Doppler and IVDSA examinations revealed a non‐symptomatic re‐stenosis of the relevant internal carotid artery in 2 patients. There were no relevant occlusions and no symptomatic re‐stenoses were detected. Spectral spreading of the Doppler signal at the site of the endarterectomy was found in 18% of the internal carotid arteries, whereas wall irregularities (diameter reduction less than 10%) were demonstrated in 25% by IVDSA. A stenosis or occlusion was found in 14 (25%) of the 57 ipsilateral external carotid arteries.

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Noninvasive Detection of Carotid Stenosis Following Endarterectomy

Cited by 75 publications

References 9 publications

Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

Relation between blood lipids, lipoproteins, and cerebrovascular atherosclerosis. A review.

Patency and flow velocity profiles in the internal carotid artery assessed by digital subtraction angiography and Doppler studies two years after endarterectomy

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