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• W2000680322 abstract "Duplex scanning has detected the highest incidence of recurrent stenosis (15% to 50%)1Thomas M Otis SM Rush M Zygroff J Dilley RB Bernstein EF Recurrent carotid artery stenosis following endarterectomy.Ann Surg. 1984; 200: 74-79Crossref PubMed Scopus (82) Google Scholar, 2Aldoori MI Baird RN Prospective assessment of carotid endarterectomy by clinical and ultrasonic methods.Br J Surg. 1987; 74: 926-929Crossref PubMed Scopus (23) Google Scholar, 3Nicholls SC Phillips DJ Bergelin RO Beach KW Primozich JF Strandness DE Carotid endarterectomy. Relationship of outcome to early restenosis.J Vasc Surg. 1985; 2: 375-381PubMed Scopus (65) Google Scholar, 4Zierler RE Bandyk DF Thiele BL Strandness DE Carotid artery stenosis following endarterectomy.Arch Surg. 1982; 117: 1408-1415Crossref PubMed Scopus (225) Google Scholar after carotid endarterectomy. Turbulent blood flow may arise from residual stenosis, recurrent stenosis, or compliance mismatch between the soft endarterectomized segment and the relatively stiff artery. This flow later may become laminar2Aldoori MI Baird RN Prospective assessment of carotid endarterectomy by clinical and ultrasonic methods.Br J Surg. 1987; 74: 926-929Crossref PubMed Scopus (23) Google Scholar, 5Ackerstaff RGA Sanders EACM Hoeneveld H Eikelboom BC Vermeulen FEE Lugwig JW Residual lesions and early restenosis after internal carotid endarterectomy.in: Presented at the Second International Vascular Symposium, LondonSeptember 1986Google Scholar and Ackerstaff et al.5Ackerstaff RGA Sanders EACM Hoeneveld H Eikelboom BC Vermeulen FEE Lugwig JW Residual lesions and early restenosis after internal carotid endarterectomy.in: Presented at the Second International Vascular Symposium, LondonSeptember 1986Google Scholar reported that most mild spectral broadening detected 3 months after operation disappeared or remained stable during follow-up. We showed that 36% of the arteries with spectral broadening had returned to normal at the 6-month review.2Aldoori MI Baird RN Prospective assessment of carotid endarterectomy by clinical and ultrasonic methods.Br J Surg. 1987; 74: 926-929Crossref PubMed Scopus (23) Google Scholar Russell et al.6Russell D Balle SJ Wiberg J Nakstad P Nyberg-Hansen R Patency and flow velocity profiles in the internal carotid artery assessed by digital subtraction angiography and Doppler studies three months following endarterectomy.J Neurol Neurosurg Psychiatr. 1986; 49: 183-186Crossref PubMed Scopus (10) Google Scholar studied 60 endarterectomized arteries with spectral analysis of Doppler signal and intravenous digital subtraction angiography (DSA). Spectral broadening was identified in half of the arteries, whereas DSA detected irregularities in only 25%. Diaz et al.7Diaz FG Patel S Boulos R Ausman JI Early angiographic changes following carotid endarterectomy. (Abstract).Stroke. 1980; 11: 35Crossref PubMed Scopus (116) Google Scholar showed that 20% of the early angiographic abnormalities had disappeared 6 weeks after initial evaluation. Therefore it is more comprehensive to classify this category as flow disturbance rather than less than 50% stenosis like the preoperative situation. The endarterectomized segment is a site of active cellular proliferation and remodeling. Recurrent stenosis caused by myointimal hyperplasia is characterized by smooth tapered narrowing, which may produce high-velocity laminar flow. A critical point may be reached where smooth laminar flow can no longer be maintained. Therefore two types of high-velocity signals (greater than 4 kHz) have been observed and both used to indicate greater than 50% stenosis2Aldoori MI Baird RN Prospective assessment of carotid endarterectomy by clinical and ultrasonic methods.Br J Surg. 1987; 74: 926-929Crossref PubMed Scopus (23) Google Scholar: “soft” signals that have minimal or no spectral broadening and “harsh” signals with marked spectral broadening. The former signals can also arise because of flow augmentation in the presence of an occluded contralateral artery.2Aldoori MI Baird RN Prospective assessment of carotid endarterectomy by clinical and ultrasonic methods.Br J Surg. 1987; 74: 926-929Crossref PubMed Scopus (23) Google Scholar Few reports exist that compare postoperative duplex scanning and angiography. Nevertheless, there is a suggestion that the current criteria may overestimate the diagnosis of greater than 50% recurrent stenosis. Roederer et al.,8Roederer GO Langlois Y Chan ATW et al.Postendarterectomy carotid ultrasonic duplex scanning: concordance with contrast angiography.Ultrasound Med Biol. 1983; 9: 73-78Abstract Full Text PDF PubMed Scopus (26) Google Scholar using both modalities, showed that 19% of the arteries were overestimated by duplex scanning into the category of greater than 50% recurrent stenosis. Recently, Pelz et al.9Pelz D Rankin RN Ferguson GG Intravenous digital subtraction angiography and duplex ultrasonography in postoperative assessment of carotid endarterectomy.J Neurosurg. 1987; 66: 88-92Crossref PubMed Scopus (6) Google Scholar implicated intravenous DSA as the cause of underestimation of the degree of recurrent stenosis in 10 of 74 vessels. Regression of myointimal hyperplasia is a more plausible explanation. Zierler et al.4Zierler RE Bandyk DF Thiele BL Strandness DE Carotid artery stenosis following endarterectomy.Arch Surg. 1982; 117: 1408-1415Crossref PubMed Scopus (225) Google Scholar reported a reduction in the incidence of greater than 50% stenosis from 36% to 19% within 16 months after operation. Others have shown 10% and 5% reduction in the incidence of greater than 50% stenosis during a mean follow-up of 18 months. We reported that 75% of the endarterectomized arteries with “soft” high-velocity signals reverted to normal by the end of our study. In view of the differing prognostic implications of “soft” and “harsh” high-velocity signals in postendarterectomy scans, it would seem wise to characterize these signals as shown in Table I and Fig. 1.Table IProposed classification of postoperative duplex scanning results and comparison with the current preoperative classificationCurrent preoperative classificationProposed postoperative classificationNormalNormal-A-Systolic frequency up to 4 kHzNo spectral broadening1%-49%Flow disturbance-B-Systolic frequency up to 4 kHzMarked spectral broadeningFlow augmentation“Soft” high-velocity signal-C-Systolic frequency > 4 kHzNo spectral broadening50%-99%“Harsh” high-velocity signal-D-Systolic frequency > 4 kHzMarked spectral broadeningOccludedOccluded-E-No diastolic flow in common, carotid enhanced flow in external carotid and no flow in internal carotid arteries Open table in a new tab Confirmation with postoperative angiography would be desirable, although we believe it is difficult to justify its routine use in asymptomatic patients." @default.
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• W2000680322 title "Proposed new classification of postendarterectomy carotid duplex scans" @default.
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