Clinical follow-up rather than duplex surveillance after carotid endarterectomy

Golledge, Jonathan; Cuming, R.; Ellis, Mary; Beattie, D.K.; Davies, Alun H.; Greenhalgh, Roger M.

doi:10.1016/s0741-5214(97)70321-5

Cited by 44 publications

(33 citation statements)

References 22 publications

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“…2 Golledge et al 1 recommended restriction of follow-up to those with ≥50% stenosis, as this protocol will reduce CDUS surveillance by 78%. Another review by Golledge et al indicated a very low yield of CDUS surveillance after CEA, with only 13 patients (5.9%) with severe disease warranting additional intervention.…”

Section: Discussionmentioning

confidence: 99%

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The value and economic analysis of routine postoperative carotid duplex ultrasound surveillance after carotid endarterectomy

AbuRahma

Srivastava

AbuRahma

et al. 2015

Journal of Vascular Surgery

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Background Several studies have reported on the role of postoperative duplex ultrasound surveillance after carotid endarterectomy (CEA) with varying results. Most of these studies had a small sample size or did not analyze cost-effectiveness. Methods We analyzed 489 of 501 CEA patients with patch closure. All patients had immediate postoperative duplex ultrasound examination and were routinely followed up both clinically and with duplex ultrasound at regular intervals of 1 month, 6 months, 12 months, and every 12 months thereafter. A Kaplan-Meier analysis was used to estimate the rate of ≥50% and ≥80% post-CEA restenosis over time and the time frame of progression from normal to ≥50% or ≥80% restenosis. The cost of post-CEA duplex surveillance was also estimated. Results Overall, 489 patients with a mean age of 68.5 years were analyzed. Ten of these had residual postoperative ≥50% stenosis, and 37 did not undergo a second duplex ultrasound examination and therefore were not included in the final analysis. The mean follow-up was 20.4 months (range, 1-63 months), with a mean number of duplex ultrasound examinations of 3.6 (range, 1-7). Eleven of 397 patients (2.8%) with a normal finding on immediate postoperative duplex ultrasound vs 4 of 45 (8.9%) with mild stenosis on immediate postoperative duplex ultrasound progressed to ≥50% restenosis (P = .055). Overall, 15 patients (3.1%) had ≥50% restenosis, 9 with 50% to <80% and 4 with 80% to 99% (2 of these had carotid artery stenting reintervention), and 2 had late carotid occlusion. All of these were asymptomatic, except for one who had a transient ischemic attack. The mean time to ≥50% to <80% restenosis was 14.7 months vs 19.8 months for ≥80% restenosis after the CEA. Freedom from restenosis rates were 98%, 96%, 94%, 94%, and 94% for ≥50% restenosis and 99%, 98%, 97%, 97%, and 97% for ≥80% restenosis at 1 year, 2 years, 3 years, 4 years, and 5 years, respectively. Freedom from myocardial infarction, stroke, and deaths was not significantly different between patients with and without restenosis (100%, 93%, 83%, and 83% vs 94%, 91%, 86%, and 79% at 1 year, 2 years, 3 years, and 4 years, respectively; P = .951). The estimated charge of this surveillance was 3.6 × 489 (number of CEAs) × $800 (charge for carotid duplex ultrasound), which equals $1,408,320, to detect only four patients with ≥80% to 99% restenosis who may have been potential candidates for reintervention. Conclusions This study shows that the value of routine postoperative duplex ultrasound surveillance after CEA with patch closure may be limited, particularly if the finding on immediate postoperative duplex ultrasound is normal or shows minimal disease.

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Section: Discussionmentioning

confidence: 99%

“…1-5 Advancements in medical treatment and the current emphasis on cost-effectiveness have questioned the value of performing routine carotid ultrasound scanning after CEA.…”

mentioning

confidence: 99%

The value and economic analysis of routine postoperative carotid duplex ultrasound surveillance after carotid endarterectomy

AbuRahma

Srivastava

AbuRahma

et al. 2015

Journal of Vascular Surgery

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“…This may result from special morphology of early restenosis (myointimal hyperplasia) which has evidently low embolic potential. However, the development of typical atherosclerotic plaques is often on later stages of restenosis [15][16][17]. Thus, rate of cerebrovascular complications may be different in patients with early and later restenosis [18,19].…”

Section: Discussionmentioning

confidence: 99%

Embolic potential and ultrasonic characteristics of plaques in patients with severe unilateral carotid restenosis more than one year after surgery

Telman

Kouperberg

Hlebtovsky

et al. 2009

Journal of the Neurological Sciences

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“…The reason for the embolization as the etiology of most strokes is that few infarcts are in watershed areas [24], microemboli can be detected in the middle cerebral artery [25], and stenosis or restenosis of similar hemodynamic severity are much less likely to be associated with stroke when asymptomatic plaque is present [5,6,26]. Furthermore, Marcus et al, [27] reported that the frequency of embolization on transcranial Doppler is greater in patients with recent symptoms, such as transient ischemic attack, when compared with patients with similar severe asymptomatic disease.…”

Section: Mechanism Of Stroke In Carotid Artery Diseasementioning

confidence: 99%

Symptomatic vs. Asymptomatic Plaque Classification in Carotid Ultrasound

et al. 2011

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Quantitative characterization of carotid atherosclerosis and classification into symptomatic or asymptomatic type is crucial in both diagnosis and treatment planning. This paper describes a computer-aided diagnosis (CAD) system which analyzes ultrasound images and classifies them into symptomatic and asymptomatic based on the textural features. The proposed CAD system consists of three modules. The first module is preprocessing, which conditions the images for the subsequent feature extraction. The feature extraction stage uses image texture analysis to calculate Standard deviation, Entropy, Symmetry, and Run Percentage. Finally, classification is performed using AdaBoost and Support Vector Machine for automated decision making. For Adaboost, we compared the performance of five distinct configurations (Least Squares, Maximum- Likelihood, Normal Density Discriminant Function, Pocket, and Stumps) of this algorithm. For Support Vector Machine, we compared the performance using five different configurations (linear kernel, polynomial kernel configurations of different orders and radial basis function kernels). SVM with radial basis function kernel for support vector machine presented the best classification result: classification accuracy of 82.4%, sensitivity of 82.9%, and specificity of 82.1%. We feel that texture features coupled with the Support Vector Machine classifier can be used to identify the plaque tissue type. An Integrated Index, called symptomatic asymptomatic carotid index (SACI), is proposed using texture features to discriminate symptomatic and asymptomatic carotid ultrasound images using just one index or number. We hope this SACI can be used as an adjunct tool by the vascular surgeons for daily screening.

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Clinical follow-up rather than duplex surveillance after carotid endarterectomy

Cited by 44 publications

References 22 publications

The value and economic analysis of routine postoperative carotid duplex ultrasound surveillance after carotid endarterectomy

The value and economic analysis of routine postoperative carotid duplex ultrasound surveillance after carotid endarterectomy

Embolic potential and ultrasonic characteristics of plaques in patients with severe unilateral carotid restenosis more than one year after surgery

Symptomatic vs. Asymptomatic Plaque Classification in Carotid Ultrasound

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