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.
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.
Authors: R Oteros; E Jimenez-Gomez; F Bravo-Rodriguez; J J Ochoa; R Guerrero; F Delgado Journal: AJNR Am J Neuroradiol Date: 2012-03-15 Impact factor: 3.825
Authors: R Eugene Zierler; Kirk W Beach; Robert O Bergelin; Brajesh K Lal; Wesley S Moore; Gary S Roubin; Jenifer H Voeks; Thomas G Brott Journal: J Vasc Surg Date: 2013-09-19 Impact factor: 4.268
Authors: Kevin A Brown; Dina S Itum; Yazan Duwayri; James G Reeves; Ravi Rajani; Ravi K Veeraswamy; Shipra Arya; Atef Salam; Thomas F Dodson; Luke P Brewster Journal: Ann Vasc Surg Date: 2014-06-12 Impact factor: 1.466
Authors: J Kammler; H Blessberger; T Lambert; J Kellermair; M Grund; A Nahler; M Lichtenauer; S Schwarz; C Reiter; C Steinwender; A Kypta Journal: Clin Res Cardiol Date: 2017-02-08 Impact factor: 5.460
Authors: Damon S Pierce; Eric B Rosero; J Gregory Modrall; Beverley Adams-Huet; R James Valentine; G Patrick Clagett; Carlos H Timaran Journal: J Vasc Surg Date: 2009-03 Impact factor: 4.268
Authors: Brajesh K Lal; Kirk W Beach; Gary S Roubin; Helmi L Lutsep; Wesley S Moore; Mahmoud B Malas; David Chiu; Nicole R Gonzales; J Lee Burke; Michael Rinaldi; James R Elmore; Fred A Weaver; Craig R Narins; Malcolm Foster; Kim J Hodgson; Alexander D Shepard; James F Meschia; Robert O Bergelin; Jenifer H Voeks; George Howard; Thomas G Brott Journal: Lancet Neurol Date: 2012-08-02 Impact factor: 44.182
Authors: Floris Tm Bosch; Jeroen Hendrikse; Indran Davagnanam; Leo H Bonati; Aad van der Lugt; H B van der Worp; Gert J de Borst; Willem Mali; Martin M Brown; Paul J Nederkoorn Journal: Eur Stroke J Date: 2016-11-04