Document Detail

Ultrasound criteria for severe in-stent restenosis following carotid artery stenting.
MedLine Citation:
PMID:  18178456     Owner:  NLM     Status:  MEDLINE    
PURPOSE: In-stent restenosis (ISR) is a known complication following carotid artery stenting (CAS). However, ultrasound criteria determining ISR are not well established. We evaluated alternative ultrasound velocity criteria for >70% ISR in our institution.
METHODS: Clinical records of 256 patients undergoing 282 consecutive CAS procedures over a 42-month period were reviewed. Follow-up ultrasounds were available for analysis in 237 patients. Selective angiograms and repeat interventions were performed for >70% ISR. Ultrasound criteria including peak systolic velocity (PSV), end diastolic velocity (EDV), and internal carotid to common carotid artery ratios (ICA/CCA) were examined. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for PSV (200, 250, 300, 350, and 400 cm/s), EDV (70, 80, 90, 100 cm/s), and CCA/ICA (3, 3.5, 4, 4.5, 5).
RESULTS: Twenty-two carotid angiograms were performed and 18 lesions had confirmations of >70% ISR in 11 patients including prior CEA in five patients and neck irradiation in two patients. Receiver operator characteristics (ROC) was analyzed for PSV, EDV, and CCA/ICA ratio. For 70% or greater angiographic ISR, PSV > 300 cm/s correlated to a 94% sensitivity, 50% specificity, 90% positive predictive value (PPV), and 67% negative predictive value (NPV); EDV > 90 cm/s correlated to an 89% sensitivity, 100% specificity, 100% PPV, and 67% NPV; and ICA/CCA > 4 had a 94.4% sensitivity, 75% specificity, 94% PPV, and 75% NPV. A significant color flow disturbance was detected in one patient who did not meet the aforementioned ultrasound velocity criteria. Further statistical analysis showed that an EDV of 90 cm/s provided the best discriminant value.
CONCLUSION: Our study demonstrated that PSV > 300 cm/s, EDV > 90 cm/s, and ICA/CCA > 4 correlated well with >70% ISR. Although still rudimentary, these velocity criteria combined with color flow patterns can reliably predict severe ISR in our vascular laboratory. However, due to the relatively infrequent cases of severe ISR following CAS, a multicentered study is warranted to establish standard post-CAS ultrasound surveillance criteria for severe ISR.
Wei Zhou; Deborah D Felkai; Mark Evans; Sally A McCoy; Peter H Lin; Panagiotos Kougias; Hosam F El-Sayed; Alan B Lumsden
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  47     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-07     Completed Date:  2008-02-28     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  74-80     Citation Subset:  IM    
Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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MeSH Terms
Aged, 80 and over
Blood Flow Velocity
Carotid Stenosis / physiopathology,  radiography,  surgery,  ultrasonography*
Follow-Up Studies
Middle Aged
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Sensitivity and Specificity
Severity of Illness Index
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Color
Ultrasonography, Doppler, Duplex*
Vascular Surgical Procedures / instrumentation*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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