Standard duplex criteria overestimate the degree of stenosis after eversion carotid endarterectomy

Benzing, Travis; Wilhoit, Cameron; Wright, Sharee; McCann, P. Aaron; Lessner, Susan M.

doi:10.1016/j.jvs.2015.01.039

Cited by 8 publications

(6 citation statements)

References 34 publications

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“…[34][35][36][37][38] Emerging data suggest the need for similar revisions to velocity criteria after CEA; however, additional studies need to be performed before firm recommendations can be made. 40,41…”

Section: Risk Factors For Carotid Restenosismentioning

confidence: 99%

The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures

Zierler

Jordan

Lal

et al. 2018

Journal of Vascular Surgery

147

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Although follow-up after open surgical and endovascular procedures is generally regarded as an important part of the care provided by vascular surgeons, there are no detailed or comprehensive guidelines that specify the optimal approaches with regard to testing methods, indications for reintervention, and follow-up intervals. To provide guidance to the vascular surgeon, the Clinical Practice Council of the Society for Vascular Surgery appointed an expert panel and a methodologist to review the current clinical evidence and to develop recommendations for follow-up after vascular surgery procedures. For those procedures for which high-quality evidence was not available, recommendations were based on observational studies, committee consensus, and indirect evidence. Recognizing that there are numerous published reports on the role of duplex ultrasound for surveillance of infrainguinal vein bypass grafts, the Society commissioned a systematic review and meta-analysis on this topic. The panel classified the strength of each recommendation and the corresponding quality of evidence on the basis of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system: recommendations were graded either strong or weak, and the quality of evidence was graded high, moderate, or low. The resulting recommendations represent a wide variety of open surgical and endovascular procedures involving the extracranial carotid artery, thoracic and abdominal aorta, mesenteric and renal arteries, and lower extremity arterial revascularization. The panel also identified many areas in which there was a lack of high-quality evidence to support their recommendations. This suggests that there are opportunities for further clinical research on testing methods, threshold criteria, and the role of surveillance as well as on the modes of failure and indications for reintervention after vascular surgery procedures.

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Section: Risk Factors For Carotid Restenosismentioning

confidence: 99%

The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures

Zierler

Jordan

Lal

et al. 2018

Journal of Vascular Surgery

147

View full text Add to dashboard Cite

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“…1,6,14 Therefore, standardizing cut-off values for parameters is of great significance for patient screening and evaluating clinical treatment. However, in the early 1990s, some studies [7][8][9] reported that diagnostic criteria assessed using CDU overestimated the stenosis degree for bilateral carotid artery stenosis. In 1998, van Everdingen et al 7 revealed that this overestimation was due to one side of the ICA being occluded and causing blood flow to increase on the other side of the ICA with carotid artery stenosis; this was confirmed by cerebral blood flow perfusion on MRI.…”

Section: Discussionmentioning

confidence: 99%

“… 7 , 8 Moreover, following the eversion technique for CEA, the degree of restenosis evaluated by CDU based on previous blood flow velocity criteria was overestimated. 9 However, the reason for this phenomenon is rarely mentioned in previous literature. In the clinical practice of our center, we have noticed that the anterior communicating artery patency will have a certain impact on the flow velocity measurement of the intracranial segment of the internal carotid artery (ICA).…”

Section: Introductionmentioning

confidence: 99%

Effect of anterior communicating artery patency on the flow velocity in bilateral carotid artery stenosis after carotid endarterectomy

et al. 2023

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Background: The effect of anterior communicating artery (ACoA) patency on the flow velocity of the extracranial carotid arteries is unclear. Methods: A total of 285 patients with carotid artery stenosis were included between January 2019 and January 2021. All patients received unilateral carotid endarterectomy (CEA). The patients were classified into ACoA-patent (161) and ACoA-nonpatent (124) groups using digital subtraction angiography (DSA) and/or computed tomography angiography (CTA). The peak systolic velocity (PSV) and end-diastolic velocity (EDV) measured by carotid duplex ultrasonography (CDU) were compared between both groups, pre- and post-CEA. Results: There was no significant difference in the risk factors for cerebrovascular disease between the two groups. Within 1 week after CEA, the PSV and EDV on operative and nonoperative carotid (contralateral carotid in the same patient) arteries decreased significantly (both p < 0.01). Comparison of nonoperative carotid artery pre- and post-CEA between the two groups showed that post-CEA PSV and EDV in the ACoA-patent group were significantly lower than that of pre-CEA (PSV and EDV, t = 11.507 and 6.716, respectively, both p < 0.001) (according to the Society of Radiologists in Ultrasound Consensus Conference [SRUCC] PSV standard). There was no significant difference in the ACoA-nonpatent group (PSV: t = 1.924, p = 0.057; EDV: t = 1.237, p = 0.218). In the nonoperative carotid artery of the ACoA-patent group, the degree of stenosis assessed by CDU was inconsistent with that of DSA/CTA (κ = 0.294), whereas that in the ACoA-nonpatent group had a high consistency (κ = 0.982). Among 161 ACoA-patent cases, 68 showed overestimated stenosis. Conclusions: The patent ACoA increases PSV and EDV, causing an overestimation of carotid artery stenosis.

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“…The high variability of flow velocity thresholds suggests that no single duplex ultrasound parameter can be used to reliably determine the degree of ICA restenosis after CAS or CEA. Similar to the assessment of the severity of stenosis in native ICA ( 10 ), combinations of different flow velocity criteria (PSV, EDV, or ICA/CCA ratio), B-mode and color imaging, and parameters influencing cerebral hemodynamics should be considered for a more accurate evaluation of the degree of restenosis after CEA and CAS ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Role of carotid duplex in the assessment of carotid artery restenosis after endarterectomy or stenting

Szegedi,

Potvorszki,

Mészáros

et al. 2023

Front. Neurol.

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IntroductionRedo carotid endarterectomy (CEA) and carotid stenting (CAS) are often performed when there is evidence of post-procedural restenosis. The incidence of restenosis after carotid reconstruction is not negligible, ranging from 5 to 33%. The diagnosis of significant internal carotid artery (ICA) restenosis is usually based on duplex ultrasound (US) criteria, mostly on peak-systolic flow velocity (PSV). However, there have been no generally accepted duplex US criteria for carotid restenosis after CAS or CEA.MethodsIn this systematic review, the PubMed/ Medline and Scopus databases were screened to find trials that reported duplex US criteria for significant restenosis after CEA and/or CAS. Only those reports were analyzed in which the restenoses were also assessed by CT/MR or digital subtraction angiography as comparators for duplex US.ResultsFourteen studies met the predetermined search criteria and were included in this review. In most studies, PSV thresholds for significant in-stent ICA restenosis after CAS were higher than those for significant stenosis in non-procedurally treated (native) ICA. Many fewer studies investigated the US criteria for ICA restenosis after CEA. Despite the heterogeneous data, there is a consensus to use higher flow velocity thresholds for assessment of stenosis in stented ICA than in native ICA; however, there have been insufficient data about the flow velocity criteria for significant restenosis after CEA. Although the flow velocity thresholds for restenosis after CAS and CEA seem to be different, the large studies used the same duplex criteria to define restenosis after the two procedures. Moreover, different studies used different flow velocity thresholds to define ICA restenosis, leading to variable restenosis rates.DiscussionWe conclude that (1) further examinations are warranted to determine appropriate duplex US criteria for restenosis after CAS and CEA, (2) single duplex US parameter cannot be used to reliably determine the degree of ICA restenosis, (3) inappropriate US criteria used in large studies may have led to false restenosis rates, and (4) studies are required to determine if there is a benefit from redo carotid artery procedure, such as redo-CEA or redo-CAS, starting with prospective risk stratification studies using current best practice non-invasive care alone.

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Standard duplex criteria overestimate the degree of stenosis after eversion carotid endarterectomy

Abstract: The presence of hemodynamically significant carotid artery restenosis may be overestimated by standard duplex criteria after eCEA and perhaps after pCEA. Insufficient information currently exists to determine what PSV does correspond to hemodynamically significant restenosis.

Cited by 8 publications

References 34 publications

The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures

The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures

Effect of anterior communicating artery patency on the flow velocity in bilateral carotid artery stenosis after carotid endarterectomy

Role of carotid duplex in the assessment of carotid artery restenosis after endarterectomy or stenting

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