Surveillance Duplex Ultrasound After Carotid Endarterectomy: Contralateral Carotid Stenosis, Restenosis and Cost

2017 ◽  
Vol 41 ◽  
pp. 12-13
Author(s):  
R. Clement Darling ◽  
John B. Taggert ◽  
Yaron Sternbach ◽  
Sean P. Roddy ◽  
Paul B. Kreienberg
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Duplex Ultrasound

From embolization to remodeling: the need for early carotid endarterectomy in symptomatic carotid plaques

Vascular ◽  
2011 ◽  
Vol 19 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Laura Capoccia ◽  
Caterina Pelonara ◽  
Cesira Imondi ◽  
Enrico Sbarigia ◽  
Francesco Speziale
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Duplex Ultrasound ◽  
Left Carotid Artery ◽  
Symptomatic Carotid ◽  
Atheromatous Plaques ◽  
Dynamic Structures ◽  
Arterial Stenoses

Atheromatous plaques are dynamic structures undergoing continuous remodeling. Duplex ultrasound is now an accepted technique to classify the severity of arterial stenoses. It gives information about the ultrasonic echogenicity of tissue, the plaque surface and the velocity of blood flowing through vessels with the latest equipment. We report the case of a 59-year-old male patient with left hemispheric stroke and a 50% left carotid artery stenosis whose remodeling and reabsorption developed throughout three months from the onset of symptoms. Plaque surface and structural echomorphology assessment and standardization, along with the degree of carotid stenosis, might be helpful in identifying patients most likely to benefit from carotid endarterectomy.

scholarly journals Digital subtraction angiography (DSA) is superior to duplex ultrasound in diagnosis of extracranial carotid stenosis - a comparative study

2014 ◽  
Vol 43 (2) ◽  
pp. 67-71
Author(s):  
Subash Kanti Dey ◽  
Lipy Bakshi ◽  
Md Shahidullah ◽  
Ahsan Habib ◽  
Manabendra Battacharya ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Digital Subtraction Angiography ◽  
Internal Carotid ◽  
Duplex Ultrasound ◽  
Digital Subtraction ◽  
Sensitivity Specificity ◽  
Carotid Vessels

Digital subtraction angiography (DSA) is the gold standard investigation to assess the extracranial stenosis of carotid vessels. But this is an invasive diagnostic tool. So it is still a controversial issue whether duplex ultrasound is an alternative to DSA for measurement of stenosis of carotid vessels. This prospective crossectional observational study was conducted in the department of Neurology, BSMMU, Dhaka from May 2012 to April 2013 to assess the diagnostic accuracy of duplex ultrasound and its potential to replace DSA before performing carotid endarterectomy (CEA) and carotid stenting. Total of 38 patients, 33 patients of nondisabling ischaemic stroke and 5 patients with history of TIAs whose extracranial carotid stenosis was >50% on duplex ultrasound were selected for DSA. DSA was done on these vessels and stenosis was measured using NASCET criteria. Results of USD and DSA were compared to determine the sensitivity, specificity and accuracy of duplex ultrasound (USD). At 70% stenosis of right internal carotid artery and left internal carotid artery the sensitivity, specificity and accuracy were 93.8%, 63.7%, 89.5% and 93.3%, 75%, 89.5% respectively. This level of diagnostic efficiency of USD is less than that of DSA of carotid arteries. It was found in this study that, USD underestimates or overestimates the degree of carotid stenosis. DSA was safe and effective in determining stenosis in this study & there was no 67 complication. So before taking any decision for carotid endarterectomy or carotid artery stenting, digital subtraction angiography of carotid vessels should be done. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21385 Bangladesh Med J. 2014 May; 43 (2): 67-71

scholarly journals Systematic review of preoperative carotid duplex ultrasound compared with computed tomography carotid angiography for carotid endarterectomy

2019 ◽  
Vol 101 (3) ◽  
pp. 141-149 ◽  
Author(s):  
T Forjoe ◽  
M Asad Rahi
Keyword(s):  
Computed Tomography ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Sensitivity And Specificity ◽  
Systematic Reviews ◽  
Imaging Modality ◽  
Duplex Ultrasound ◽  
Carotid Angiography ◽  
Carotid Duplex ◽  
Cochrane Database

Introduction We reviewed the literature for preoperative computed tomography carotid angiography and/or carotid duplex to determine their respective sensitivity and specificity in assessing the degree of carotid stenosis. We aimed to identify whether one imaging modality can accurately identify critical stenosis in patients presenting with transient ischaemic attack or symptoms of a cerebrovascular accident requiring carotid endarterectomy. Methods Systematic search of MEDLINE, Embase, Cochrane database of systematic reviews, all Evidence-Based Medicine Reviews (Cochrane Database of Systematic Reviews, ACP Journal club, Database of Abstracts of Reviews of Effects, Cochrane Clinical Answers, Cochrane Controlled Trials Register, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database) for primary studies relating to computed tomography carotid angiography (CTA) and/or carotid duplex ultrasound (CDU). Studies included were published between 1990 and 2018 and focused on practice in the UK, Europe and North America. Results The sensitivity and specificity of CTA and CDU are comparable. CDU is safe and readily available in the clinical environment hence its use in the initial preoperative assessment of carotid stenosis. CDU is an adequate imaging modality for determining stenosis greater than 70%; sensitivity and specificity are improved when the criteria for determining greater than 70% stenosis are adjusted. Vascular laboratories opting to use duplex as their sole imaging modality should assess the sensitivity and specificity of their own duplex procedure before altering practice to preoperative single imaging for patients. Conclusions The sensitivity and specificity of CTA (90.6% and 93%, respectively) and CDU (92.3% and 89%, respectively) are comparable. Both are dependent on criteria used in vascular laboratories. CDU sensitivity and specificity was improved to 98.7% and 94.1%, respectively, where peak systolic velocity and end diastolic velocity were assessed. Either modality can be used to determine greater than 70% stenosis, although a secondary imaging modality may be required for cases of greater than 50% stenosis.

Outcome after carotid endarterectomy for asymptomatic carotid stenosis

1994 ◽  
Vol 41 (6) ◽  
pp. 443-449 ◽  
Author(s):  
Richard B. Libman ◽  
Ralph L. Sacco ◽  
Tianying Shi ◽  
James W. Correll ◽  
J.P. Mohr
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

High Intensity Transient Signals in Patients with Carotid Stenosis May Persist after Carotid Endarterectomy

2003 ◽  
Vol 17 (2-3) ◽  
pp. 123-127 ◽  
Author(s):  
Kazumi Kimura ◽  
Jacinda L. Stork ◽  
Christopher R. Levi ◽  
Anne L. Abbott ◽  
Geoffrey A. Donnan ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
High Intensity ◽  
Transient Signals

Endovascular Advances for Extracranial Carotid Stenosis

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S92-S101 ◽  
Author(s):  
Jorge L. Eller ◽  
Travis M. Dumont ◽  
Grant C. Sorkin ◽  
Maxim Mokin ◽  
Elad I. Levy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Carotid Stenting ◽  
Historical Background ◽  
Treatment Modalities ◽  
Endovascular Management ◽  
The Past

Abstract Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background.

Transient brain ischaemia (20 January 1978, p. 6): clarification and correction

1978 ◽  
Vol 16 (23) ◽  
pp. 92-92
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Brain Ischaemia

Our statement that in patients with transient brain ischaemia carotid endarterectomy reduces the risk of a subsequent stroke from 28% to 3% (based on the report by Wylie & Ehrenfeld, 1970) should have been qualified. We should have referred also to the study by W. S. Fields et al. (J. Amer. med. Ass. 1970, 211, 1993), in which 4% of the surgically treated patients with unilateral carotid stenosis and 12% of the controls had a stroke during the follow-up period of, on average, 3½ years. These results are based on a small total number of strokes and remain inconclusive. The paper by Whisnant was cited in error. The conclusion of our article is not affected.

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