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Indications for carotid artery surgery and stent: The role of carotid ultrasound

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Abstract

Carotid artery disease is the most frequently identified cause of ischemic stroke and is mostly due to atherosclerotic disease. Landmark trials have demonstrated that surgical intervention in cases of high-grade carotid stenosis can reduce the risk of subsequent stroke. Endovascular approaches continue to be evaluated in ongoing trials. Careful patient selection is critical if the potential benefits of carotid revascularization are to be realized. Ultrasound is a safe, accurate, readily available method to evaluate carotid artery disease. The degree of stenosis is the parameter most frequently used to make decisions about therapeutic approaches. Plaque characteristics may also be useful for identifying high-risk patients. Microembolic signals detected by transcranial Doppler ultrasound can identify cerebral embolization before or after carotid intervention. This review discusses the current clinical role of carotid ultrasound in the selection of patients for the two most frequently used carotid interventions: carotid endarterectomy or carotid angioplasty and stenting.

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References and Recommended Reading

  1. Saco RL: Extracranial carotid stenosis. N Engl J Med 2001, 345:1113–1118.

    Article  Google Scholar 

  2. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. European Carotid Surgery Trialists’ Collaborative Group [no authors listed]. Lancet 1991, 337:1235–1243.

  3. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators [no authors listed]. N Engl J Med 1991, 325:445–453.

  4. Mohammed N, Anand SS: Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. MRC asymptomatic carotid surgery trial (ACST) collaborative group. Lancet 2004, 363:1491–1502.

    Article  Google Scholar 

  5. Young B, Moore WS, Robertson JT, et al.: An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators Asymptomatic Carotid Arteriosclerosis Study. Stroke 1996, 27:2216–2224.

    PubMed  CAS  Google Scholar 

  6. Goldstein LB, Adams R, Becker K, et al.: Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke 2001, 32:280–299.

    PubMed  CAS  Google Scholar 

  7. Saco RL, Adams R, Albers G, et al.: Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke. Stroke 2006, 37:577–617.

    Article  Google Scholar 

  8. Gorelick PB, Sacco RL, Smith DB, et al.: Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA 1999, 281:1112–1120.

    Article  PubMed  CAS  Google Scholar 

  9. Barnett HJM: Carotid endarterectomy. Lancet 2004, 363:1486–1487.

    Article  PubMed  CAS  Google Scholar 

  10. Chaturvedi S, Bruno A, Feasby T, et al.: Carotid endarterectomy—an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2005, 65:794–801.

    Article  PubMed  CAS  Google Scholar 

  11. Rothwell PM, Eliasziw M, Gutnikov SA, et al.: Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003, 361:107–116.

    Article  PubMed  CAS  Google Scholar 

  12. Endarterectomy for asymptomatic carotid artery stenosis. Executive committee for the Asymptomatic Carotid Atherosclerosis Study [no authors listed]. JAMA 1995, 273:1421–1428.

  13. Ferguson RD, Ferguson JG: Carotid angioplasty. In search of a worthy alternative to endarterectomy. Arch Neurol 1996, 53:696–698.

    PubMed  CAS  Google Scholar 

  14. Bates ER, Babb JD, Casey DE Jr, et al.: ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting. Vasc Med 2007, 12:35–83.

    Article  PubMed  Google Scholar 

  15. Cambria RP: Stenting for carotid-artery stenosis. N Engl J Med 2004, 351:1565–1567.

    Article  PubMed  CAS  Google Scholar 

  16. Yadav JS, Wholey MH, Kuntz RE, et al.: Protected carotidartery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004, 351:1493–1501.

    Article  PubMed  CAS  Google Scholar 

  17. The Centers for Medicare and Medicaid Services (CMS): Coverage Decision Memorandum for Carotid Artery Stenting. Available at http://www.cms.hhs.gov. Accessed September 10, 2007.

  18. Hobson RW 2nd, Howard VJ, Brott TG, et al.: Organizing the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): National Institutes of Health, Health Care Financing Administration, and industry funding. Curr Control Trials Cardiovasc Med 2001, 13:160–164.

    Article  Google Scholar 

  19. Brott TG, Brown RD, Meyer FB, et al.: Carotid revascularization for prevention of stroke: carotid endarterectomy and carotid artery stenting. Mayo Clin Proc 2004, 79:1197–1208.

    Article  PubMed  Google Scholar 

  20. Cremonesi A, Setacci C, Bignamini A, et al.: Carotid artery stenting: first consensus document of the ICCS-SPREAD Joint Committee. Stroke 2006, 37:2400–2409.

    Article  PubMed  Google Scholar 

  21. Spencer MP, Reid JM: Quantification of carotid stenosis with continuous wave (C-W) Doppler ultrasound. Stroke 1979, 10:793–798.

    Google Scholar 

  22. Tegeler CH, Ratanakorn D: Carotid and vertebral duplex scanning in secondary stroke prevention and stenting. In Cerebrovascular Ultrasound in Stroke Prevention and Treatment. Edited by Alexandrov A. Malden, MA: Blackwell Publishing; 2004:161–169.

    Chapter  Google Scholar 

  23. Tegeler CH, Ratanakorn D, Kim J: Advances in carotid ultrasound. Semin Cerebrovasc Dis 2005, 5:74–82.

    Article  Google Scholar 

  24. Gaitini D, Soundack M: Diagnosing carotid stenosis by Doppler sonography. J Ultrasound Med 2005, 24:1127–1136.

    PubMed  Google Scholar 

  25. Grant EG, Benson CB, Moneta GL, et al.: Carotid artery stenosis: gray-scale and Doppler US diagnosis—Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003, 229:340–346.

    Article  PubMed  Google Scholar 

  26. Soulez G, Therasse E, Robillard P, et al.: The value of internal carotid systolic velocity ratio for assessing carotid artery stenosis with Doppler sonography. AJR Am J Roentgenol 1999, 172:207–212.

    PubMed  CAS  Google Scholar 

  27. Robinson ML, Sacks D, Perlmutter GS, Marinelli DL: Diagnostic criteria for carotid duplex sonography. AJR Am J Roentgenol 1988, 151:1045–1049.

    PubMed  CAS  Google Scholar 

  28. Jones AM: Quality assurance in the vascular laboratory. In Neurosonology. Edited by Tegeler CH, Babikian VL, Gomez CR. St. Louis, MO: Mosby-Year Book; 1996:489–493.

    Google Scholar 

  29. Bluth EI: Evaluation and characterization of carotid plaque. Semin Ultrasound CT MR 1997, 8:57–65.

    Article  Google Scholar 

  30. Thiele BL, Jones AM, Hobson RW, et al.: Standards in noninvasive cerebrovascular testing. Report from the Committee on Standards for Noninvasive Vascular Testing of the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. J Vasc Surg 1992, 15:495–503.

    Article  PubMed  CAS  Google Scholar 

  31. Sterpetti AV, Schultz RD, Feldhaus RJ, et al.: Ultrasonic features of carotid plaque and the risk of subsequent neurologic deficits. Surgery 1988, 104:652–660.

    PubMed  CAS  Google Scholar 

  32. Mathur A, Roubin GS, Iyer SS, et al.: Predictors of stroke complicating carotid artery stenting. Circulation 1998, 97:1239–1245.

    PubMed  CAS  Google Scholar 

  33. Qureshi AI, Luft AR, Janardhan V, et al.: Identification of patients at risk for periprocedural neurological deficits associated with carotid angioplasty and stenting. Stroke 2000, 31:376–382.

    PubMed  CAS  Google Scholar 

  34. Polak JF, Shemanski L, O’Leary DH, et al.: Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults aged 65 years or older. Cardiovascular Health Study. Radiology 1998, 208:649–654.

    PubMed  CAS  Google Scholar 

  35. Tegos TJ, Kalomiris KJ, Sabetai MM, et al.: Significance of sonographic issue and surface characteristics of carotid plaques. Am J Neuroradiol 2001, 22:1605–1612.

    PubMed  CAS  Google Scholar 

  36. Kagawa R, Moritake K, Shima T, Okada Y: Validity of B-mode ultrasonographic findings in patients undergoing carotid endarterectomy in comparison with angiographic and clinicopathologic feature. Stroke 1996, 27:700–705.

    PubMed  CAS  Google Scholar 

  37. Pedro LM, Pedro MM, Goncalves I, et al.: Computer-assisted carotid plaque analysis: characteristics of plaques associated with cerebrovascular symptoms and cerebral infarction. Eur J Vasc Endovasc Surg 2000, 19:118–123.

    Article  PubMed  CAS  Google Scholar 

  38. Biasi G, Froio A, Diethrich EB, et al.: Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) Study. Circulation 2004, 110:756–762.

    Article  PubMed  Google Scholar 

  39. Markus HS, MacKinnon A: Asymptomatic embolization detected by Doppler ultrasound predicts stroke risk in symptomatic carotid artery stenosis. Stroke 2005, 36:971–975.

    Article  PubMed  Google Scholar 

  40. Basic identification criteria of Doppler microembolic signals. Consensus Committee of the Ninth International Cerebral Hemodynamic Symposium [no authors listed]. Stroke 1995, 26:1123.

    Google Scholar 

  41. Abbott AL, Chambers BR, Stork JL, et al.: Embolic signals and prediction of ipsilateral stroke or transient ischemic attack in asymptomatic carotid stenosis: a multicenter prospective cohort study. Stroke 2005, 36:1128–1133.

    Article  PubMed  Google Scholar 

  42. Blakeley DD, Oddone EZ, Hasselblad V, et al.: Non-invasive carotid artery testing: a meta-analytic review. Ann Intern Med 1995, 122:360–367.

    PubMed  CAS  Google Scholar 

  43. Filis KA, Arko FR, Johnson BL, et al.: Duplex ultrasound criteria for defining the severity of carotid stenosis. Ann Vasc Surg 2002, 16:413–421.

    Article  PubMed  Google Scholar 

  44. Landwehr P, Schulte O, Voshage G: Ultrasound examination of carotid and vertebral arteries. Eur Radiol 2001, 11:1521–1534.

    Article  PubMed  CAS  Google Scholar 

  45. Alexandrov AV, Brodie DS, McLean A, et al.: Correlation of peak systolic velocity and angiographic measurement of carotid stenosis. Stroke 1997, 28:339–342.

    PubMed  CAS  Google Scholar 

  46. Johnston DCC, Eastwood JD, Nguyen T, Goldstein LB: Contrast-enhanced magnetic resonance angiography of carotid arteries. Stroke 2002, 33:2834–2838.

    Article  PubMed  Google Scholar 

  47. Pan XM, Saloner D, Reilly LM, et al.: Assessment of carotid artery stenosis by ultrasonography, conventional angiography, and magnetic resonance angiography: correlation with ex vivo measurement of plaque stenosis. J Vasc Surg 1995, 21:82–88.

    Article  PubMed  CAS  Google Scholar 

  48. Johnston DC, Goldstein LB: Clinical carotid endarterectomy decision making: noninvasive vascular imaging versus angiography. Neurology 2001, 56:1009–1015.

    PubMed  CAS  Google Scholar 

  49. Kent KC, Kuntz KM, Patel MR, et al.: Perioperative imaging strategies for carotid endarterectomy: an analysis of morbidity and cost-effectiveness in symptomatic patients. JAMA 1995, 274:888–893.

    Article  PubMed  CAS  Google Scholar 

  50. The Intersocietal Commission for the Accreditation of Vascular Laboratories: Accreditation: What is accreditation? Available at http://www.intersocietal.org/icavl/accreditation/whatis.htm. Accessed September 10, 2007.

  51. Qureshi AI, Alexandrov AV, Tegeler CH, et al.: Guidelines for screening of extracranial carotid artery disease: a statement for healthcare professionals from the multidisciplinary practice guidelines committee of the American Society of Neuroimaging; cosponsored by the Society of Vascular and Interventional Neurology. J Neuroimaging 2007, 17:19–47.

    Article  PubMed  Google Scholar 

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Correspondence to Charles H. Tegler.

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Kim, Y.J., Tegler, C.H. Indications for carotid artery surgery and stent: The role of carotid ultrasound. Curr Cardiol Rep 10, 17–24 (2008). https://doi.org/10.1007/s11886-008-0005-5

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