Arterial remodeling and hemodynamics in carotid stents: a prospective duplex ultrasound study over 2 years

Willfort-Ehringer, Andrea; Ahmadi, Ramazanali; Gruber, Doris; Gschwandtner, Michael E.; Haumer, Angelika; Haumer, Markus; Ehringer, H

doi:10.1016/j.jvs.2003.12.029

Cited by 69 publications

(61 citation statements)

References 26 publications

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“…Recent work has found a difference in the poststent velocity according to an open-versus closed-cell stent design, 18 and a limitation of this study is that we were unable to confirm or disprove this association given the small number of closed-cell stents deployed among the patients in this study. Inclusion of several different types of stents (including both closed-and open-cell designs) may explain why our results showed no significant change in velocities over time versus the findings by WillfortEhringer et al, 19 who investigated 121 closed-cell design carotid Wallstents (Boston Scientific Corporation, Natick, MA) and found a significant increase in velocities with up to 6 months of follow-up and stabilization thereafter. Another potential explanation for the opposite direction of the effect according to Acculink versus other and Precise versus other stent types may be differences in stent design, with the Acculink stent having a more tapered configura-Kim et al-Sonographic Parameters After Carotid Stenting Values in parentheses are SE.…”

Section: Discussionsupporting

confidence: 46%

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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Section: Discussionsupporting

confidence: 46%

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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“…However, acute restenosis due to plaque protrusion has been reported, because the cause of restenosis is difficult to distinguish by angiography or duplex ultrasound scanning. 8,15,35) No suitable strategy for the treatment of acute in-stent restenosis has been established.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Subacute In-stent Restenosis After Carotid Artery Stenting due to Plaque Protrusion -Case Report-

Takigawa

Matsumaru

Kubo

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 70-year-old male presented with transient ischemic attacks manifesting as right hemiparesis and motor aphasia due to severe left cervical internal carotid artery stenosis. Carotid artery stenting (CAS) using a flow-reversal system was performed without complications. However, the patient exhibited transient right hemiparesis and motor aphasia 10 days after CAS. Emergent angiography demonstrated in-stent restenosis. In-stent percutaneous transluminal angioplasty and CAS were performed successfully using a distal protection system. However, duplex ultrasound scanning revealed progressive in-stent restenosis, 3 and 6 days after the re-treatment. Emergent angiography again demonstrated in-stent restenosis. Urgent stent removal and carotid endarterectomy were performed. Plaque had prolapsed through the stent. Histological examination revealed that the specimen was mainly plaque consisting of cholesterol crystals and macrophages. The patient was able to return to independent life without neurological deficit. Repeated endovascular surgery with appropriate antiplatelet and anticoagulation therapy should be attempted initially to treat in-stent restenosis. Endarterectomy with stent removal should be considered as a rescue option, especially if plaque protrusion is identified.

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“…In particular, the compliance mismatch between the native carotid artery and the stented segment, 23 the positive arterial remodelling (stent expansion), 24,25 and the enhanced stiffness of the stent-arterial wall complex 16 can induce alterations in compliance and in carotid hemodynamics and modifications of Peterson's elastic modulus of the stented vessel. 16 Moreover, changes in wall shear stress can bring endothelial dysfunction ultimately leading to intimal hyperplasia and restenosis 26 -28 (negative arterial remodelling).…”

Section: Discussionmentioning

confidence: 99%

Grading Carotid Intrastent Restenosis

Setacci

Chisci

Setacci

et al. 2008

Stroke

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Background and Purpose-The accuracy of carotid ultrasound has not been well established in predicting intrastent restenosis (ISR) after carotid artery stenting (CAS). The aim of this study is to determine different degrees of ISR using ultrasound velocity criteria compared to percentage of stenosis at angiography. Methods-This is a 6-year prospective study. After CAS procedure, each patient underwent angiography for measuring ISR (NASCET method) which was compared to peak systolic velocity (PSV), end diastolic velocity (EDV), and the ratio between PSV of internal carotid artery and common carotid artery (ICA/CCA). This was done within 48 hours, thus creating a baseline value. Ultrasound (US) examination was performed at day 30, at 3, 6, 9, and 12 months, and then yearly. Patients with an increase in PSV greater than 3 times the baseline value or in presence of PSV Ն200 cm/s underwent angiography. Results-814 CAS procedures, 6427 US examinations, and 1123 angiographies were performed. ISR Ն70% and ISR Ն50% was detected, respectively, in 22 patients and in 73 patients. We defined velocity criteria for grading carotid ISR: PSV Յ104 cm/s, if Ͻ30% stenosis; PSV:105 to 174 cm/s if 30% to 50% stenosis; PSV:175 to 299 cm/s if a 50% to 70% stenosis; PSV Ն300 cm/s, EDV Ն140 cm/s, and ICA/CCA Ն3.8 if a Ն70% stenosis. Receiver operator characteristic (ROC) curves for ISR Ն70% were, respectively, for PSV, EDV, and ICA/CCA: 0.99, 0.98, and 0.99. Conclusions-US grading of carotid ISR can guarantee a correct follow-up after CAS if new customized velocity criteria are validated by skilled operators using a specific protocol of follow-up in a certified laboratory.

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Arterial remodeling and hemodynamics in carotid stents: a prospective duplex ultrasound study over 2 years

Cited by 69 publications

References 26 publications

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

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

Recurrent Subacute In-stent Restenosis After Carotid Artery Stenting due to Plaque Protrusion -Case Report-

Grading Carotid Intrastent Restenosis

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