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Ultrasound Assessment of Internal Carotid Stenosis Pre- and Post-endarterectomy of Contralateral Near-occluded Carotid
Internal carotid artery (ICA) stenosis often presents bilaterally and is a major cause of stroke. Carotid duplex ultrasound is used for stenosis estimation via peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/common carotid artery (CCA) ratio. Carotid endarterectomy (CEA) is a common surgery for ICA stenosis and carries a high risk of stroke and mortality. In ICA near occlusion with>90% stenosis, collateral flow through contralateral ICA can compensate with increased velocities, artificially elevating contralateral stenosis.
Source: Journal of Vascular Surgery - August 18, 2023 Category: Surgery Authors: Vaishnavi Aradhyula, Lauren Workman, Todd E. Russell, Gregory Kasper, Brett Aplin, Fedor Lurie Source Type: research

Society for Vascular Surgery duplex ultrasound surveillance guidelines are safe and cost effective for transcarotid artery revascularization
The objective of this study was to evaluate the usefulness and cost effectiveness of post-TCAR CDUS surveillance regimens in monitoring for in-stent restenosis (ISR) and associated stroke risk at a single-center community institution.
Source: Journal of Vascular Surgery - May 28, 2023 Category: Surgery Authors: Richard Li, Abdur Jamal, Sharon Chao, Tessabella Magliochetti Cammarata, Brian R. Beeman Source Type: research

Change in Peak Systolic Velocity Estimation in Internal Carotid Artery Following Contralateral Near Occlusive Carotid Endarterectomy
Carotid artery stenosis (CAS) is one of the main causes of stroke, as the internal carotid artery (ICA) is a major source of cerebral blood supply. A common surgical intervention for CAS is carotid endarterectomy (CEA), which carries a high risk of stroke and mortality. CEA is indicated for 50% to 99% stenosis in symptomatic patients and 60% to 99% stenosis in asymptomatic patients. Carotid duplex ultrasound is frequently used to estimate peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/common carotid artery (CCA) ratio to determine the extent of stenosis.
Source: Journal of Vascular Surgery - May 23, 2023 Category: Surgery Authors: Vaishnavi Aradhyula, Lauren R. Workman, Fedor Lurie Tags: Interactive Poster Session Source Type: research

Loss of follow-up after carotid revascularization is associated with worse long-term stroke and death
Society for Vascular Surgery practice guidelines recommend surveillance with duplex ultrasound scanning at baseline (within 3  months from discharge), every 6 months for 2 years, and annually afterward following carotid endarterectomy or carotid artery stenting. There is a growing concern regarding the significance of postoperative follow-up after several vascular procedures. We sought to determine whether 1-year loss t o follow-up (LTF) after carotid revascularization was associated with worse outcomes in the Vascular Quality Initiative (VQI) linked to Vascular Implant Surveillance and Interventional Outcomes Network (VISION) database.
Source: Journal of Vascular Surgery - September 28, 2022 Category: Surgery Authors: Nadin Elsayed, Rohini Patel, Isaac Naazie, Caitlin W. Hicks, Jeffrey J. Siracuse, Mahmoud B. Malas Source Type: research

Re-evaluating Current Postcarotid Endarterectomy Surveillance: Long-term Results From a Large Integrated Regional Health System
The appropriate postcarotid endarterectomy (CEA) surveillance protocol is actively debated. Current guidelines recommend five duplex ultrasound studies in the first two postoperative years, followed by annual scans. Yet, robust clinical trial data show low incidence of ≥70% restenosis after CEA and annual incidence of ipsilateral ischemic events of 0.5%-1.8% per year. We evaluated the long-term utility of surveillance after CEA in preventing stroke and identifying restenosis.
Source: Journal of Vascular Surgery - May 19, 2022 Category: Surgery Authors: Colleen P. Flanagan, Lue-Yen Tucker, Elizabeth M. Lancaster, Kara A. Rothenberg, Andrew L. Avins, Mai N. Nguyen-Huynh, Robert W. Chang Tags: S2: Plenary Session 2 Source Type: research

Trends in Postoperative Carotid Duplex Surveillance Ultrasound After Carotid Artery Stenting
The aim of this study was to investigate trends in surveillance carotid artery duplex examination after carotid artery stenting (CAS) and to investigate the association between post-operative duplex restenosis and long-term ipsilateral stroke/transient ischemic attack (TIA).
Source: Journal of Vascular Surgery - August 24, 2021 Category: Surgery Authors: Nathan Belkin, Scott Damrauer, Benjamin Jackson, Julia Glaser, Venkat Kalapatapu, Darren B. Schneider, Grace J. Wang Tags: PC: Poster Competition Source Type: research

Cardiac output and cerebral blood flow during carotid surgery in regional versus general anesthesia: a prospective randomized controlled study
Endarterectomy of the carotid artery (CEA) is a preventive procedure aimed at decreasing the subsequent risk of fatal or disabling stroke in patients with significant carotid stenosis. It is well known that carotid surgery under ultrasound-guided regional anesthesia (US-RA) causes a significant increase in blood pressure, heart rate and stress hormone levels due to increased sympathetic activity. However, little is known about the effects on cardiac output (CO), cardiac index (CI) and cerebral blood flow (CBF) under US-RA as compared to general anesthesia (GA).
Source: Journal of Vascular Surgery - April 19, 2021 Category: Surgery Authors: Helmuth Tauber, Werner Streif, Jennifer Gebetsberger, Lukas Gasteiger, Eve Pierer, Michael Knoflach, Gustav Fraedrich, Maria Gummerer, Josef Fritz, Corinna Velik-Salchner Source Type: research

Alternative ultrasound modalities to attempt to assess high risk asymptomatic carotid plaques
Duplex ultrasound examination, computed tomography scans, and magnetic resonance angiography have traditionally been used as noninvasive methods to assess carotid stenosis severity. The degree of stenosis in asymptomatic patients has often been used as the main criterion to assess risk for plaque embolization and stroke. There has been an effort to find alternate methods to assess vulnerable plaques. This has included many modalities, including magnetic resonance imaging and other ultrasound techniques.
Source: Journal of Vascular Surgery - September 19, 2019 Category: Surgery Authors: Jeffrey J. Siracuse Tags: Invited commentary Source Type: research

Cerebral Monitoring During Transcarotid Artery Revascularization With Flow Reversal by Transcranial Doppler Ultrasound
Transcarotid artery revascularization (TCAR) with the ENROUTE transcarotid neuroprotection and stent system (Silk Road Medical Inc, Sunnyvale, Calif) has provided vascular surgeons with a promising new tool for treating carotid artery stenosis. Results from the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER), a prospective, single-arm, multicenter trial evaluating TCAR efficacy, demonstrated a 30-day stroke rate of 1.4%. These initial results are encouraging and have led to widespread adoption of this technology.
Source: Journal of Vascular Surgery - July 22, 2019 Category: Surgery Authors: Lindsey A. Olivere, Brian Gilmore, Zachary Williams, Mitchell W. Cox, Chandler Long, Cynthia K. Shortell, Kevin W. Southerland Tags: Abstract from the 2019 Eastern Vascular Society Annual Meeting Source Type: research

Carotid Plaque Characterization In A Large Randomized Trial: Results From CREST-2
Objective measures of plaque area and tissue composition from duplex ultrasound (DUS) images may be useful for the risk stratification of patients with a greater likelihood of future adverse events (stroke, transient ischemic attacks, or amaurosis fugax) and to assess the effect of vascular risk factor modification strategies (by measuring change in overall plaque burden and/or individual plaque tissue constituents). Clinical assessment of carotid artery plaques is most commonly performed with two-dimensional DUS imaging.
Source: Journal of Vascular Surgery - July 20, 2018 Category: Surgery Authors: Brajesh K. Lal, Matthew T. Chrencik, Amir A. Khan, Michael Jones, Jospeh H. Rapp, Dipankar Mukherjee, Peter Henke, John Yokemick, Wesley S. Moore, James F. Meschia, Thomas G. Brott Tags: Abstract from the 2018 Eastern Vascular Society Annual Meeting Source Type: research

Reply
I am pleased to provide Professor Naylor with the information requested in his letter to the Editor.1 Perhaps he is guilty of a lack of follow-up, as his discussion of said manuscript has been published in the Journal of Vascular Surgery along with our article. In this natural history study of clearly asymptomatic patients, we found (mean follow-up of 5  years) an approximate twofold increase (P = .003) in transient ischemic attack (TIA) or stroke risk for patients with ≥90% vs 70% to 89% stenosis as assessed by generally accepted duplex ultrasound criteria.
Source: Journal of Vascular Surgery - May 22, 2018 Category: Surgery Authors: Richard P. Cambria Tags: Letter to the Editor Source Type: research

Regarding “Carotid endarterectomy should not be based on consensus statement duplex criteria”
Columbo and colleagues reported a favorable prognosis for medically managed patients with evidence of an internal carotid artery stenosis between 70% and 80% on ultrasound.1 However, there is no evidence that neurologic risk is higher in patients above 80% stenosis than in those with stenosis between 70% and 80%. We believe other parameters that can be obtained from transcranial Doppler ultrasound may be more useful in identifying those patients at risk of stroke who would benefit from carotid endarterectomy.
Source: Journal of Vascular Surgery - August 22, 2017 Category: Surgery Authors: Carine Boulon, Jo ël Constans Tags: Letter to the Editor Source Type: research

Performance of acoustic radiation force impulse ultrasound imaging for carotid plaque characterization with histologic validation
This study assessed the performance of acoustic radiation force impulse (ARFI) imaging, a noninvasive ultrasound elasticity imaging method, for delineating the composition of human carotid plaque in  vivo with histologic validation.
Source: Journal of Vascular Surgery - July 13, 2017 Category: Surgery Authors: Tomasz J. Czernuszewicz, Jonathon W. Homeister, Melissa C. Caughey, Yue Wang, Hongtu Zhu, Benjamin Y. Huang, Ellie R. Lee, Carlos A. Zamora, Mark A. Farber, Joseph J. Fulton, Peter F. Ford, William A. Marston, Raghuveer Vallabhaneni, Timothy C. Nichols, C Source Type: research

Noninvasive characterization of carotid plaque strain
Current risk stratification of internal carotid artery plaques based on diameter-reducing percentage stenosis may be unreliable because ischemic stroke results from plaque disruption with atheroembolization. Biomechanical forces acting on the plaque may render it vulnerable to rupture. The feasibility of ultrasound-based quantification of plaque displacement and strain induced by hemodynamic forces and their relationship to high-risk plaques have not been determined. We studied the feasibility and reliability of carotid plaque strain measurement from clinical B-mode ultrasound images and the relationship of strain to high-...
Source: Journal of Vascular Surgery - March 4, 2017 Category: Surgery Authors: Amir A. Khan, Siddhartha Sikdar, Thomas Hatsukami, Juan Cebral, Michael Jones, John Huston, George Howard, Brajesh K. Lal Source Type: research

Carotid endarterectomy should not be based on consensus statement duplex velocity criteria
Randomized trials support carotid endarterectomy (CEA) in asymptomatic patients with ≥60% internal carotid artery (ICA) stenosis. The widely referenced Society for Radiologists in Ultrasound Consensus Statement on carotid duplex ultrasound (CDUS) imaging indicates that an ICA peak systolic velocity (PSV) ≥230 cm/s corresponds to a ≥70% ICA stenosis, leading to the potential c onclusion that asymptomatic patients with an ICA PSV ≥230 cm/s would benefit from CEA. Our goal was to determine the natural history stroke risk of asymptomatic patients who might have undergone CEA based on consensus statement PSV of ≥230...
Source: Journal of Vascular Surgery - February 9, 2017 Category: Surgery Authors: Jesse A. Columbo, Bjoern D. Suckow, Claire L. Griffin, Jack L. Cronenwett, Philip P. Goodney, Timothy G. Lukovits, Robert M. Zwolak, Mark F. Fillinger Tags: Clinical paper Source Type: research

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