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Duplex Ultrasound Velocity Criteria in Carotid Artery Stenting Patients

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Noninvasive Vascular Diagnosis

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Abstract

Carotid artery stenting (CAS) has recently emerged as a less invasive alternative to carotid endarterectomy (CEA). Carotid stenting has been demonstrated to be technically feasible and safe in high-risk patients. It has been approved as an acceptable method for revascularization in circumstances where CEA yields suboptimal results. While the final role of CAS in carotid revascularization is still in evolution, it is clear that stenting will continue to be performed in an increasing number of patients with carotid stenosis. Therefore, it is anticipated that there will be a corresponding increase in the number of in-stent restenosis cases. Considerable controversy exists regarding the clinical significance and appropriate diagnostic criteria for recurrent carotid stenosis after CAS. Placing a stent in the carotid artery alters its biomechanical properties and renders it less complaint. This in turn leads to elevations in velocities that do not necessarily reflect a stenosis. If the thresholds to define normal arteries are revised upward, then duplex ultrasonography has been found to be a very effective method of post-CAS surveillance. This chapter analyzes current information on this important clinical problem and presents evidence-based recommendations for the diagnosis of recurrent carotid stenosis after CAS.

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Author information

Authors and Affiliations

  1. Department of Vascular Surgery, Baltimore VA Medical Center, Baltimore, MD, USA

    Brajesh K. Lal M.D., FACS

  2. Department of Surgery and Center for Vascular Diagnostics, University of Maryland Medical School and Vascular Service Baltimore VA Medical Center, 22 South Greene Street, S100, B00, Baltimore, MD, 21201, USA

    Brajesh K. Lal M.D., FACS

Authors
  1. Brajesh K. Lal M.D., FACS
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Correspondence to Brajesh K. Lal M.D., FACS .

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Editors and Affiliations

  1. Robert C. Byrd Health Sciences Center, Dept. Surgery, West Virginia University, MacCorkle Ave. SE 3100, Charleston, 25304, West Virginia, USA

    Ali F. AbuRahma

  2. , Interventional Cardiology, UC San Diego Sulpizio Cardiovascular Cen, 9300 Campus Point Drive 7784, La Jolla, 92037, California, USA

    Dennis F. Bandyk

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© 2013 Springer-Verlag London

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Lal, B.K. (2013). Duplex Ultrasound Velocity Criteria in Carotid Artery Stenting Patients. In: AbuRahma, A., Bandyk, D. (eds) Noninvasive Vascular Diagnosis. Springer, London. https://doi.org/10.1007/978-1-4471-4005-4_13

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  • DOI: https://doi.org/10.1007/978-1-4471-4005-4_13

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4004-7

  • Online ISBN: 978-1-4471-4005-4

  • eBook Packages: MedicineMedicine (R0)

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