Management of carotid stenosis. History and today
Internal carotid stenosis constitutes a significant clinical challenge, since it is the cause of 20–25% of ischemic brain strokes. The management of the internal carotid stenosis for many years has been raising controversies amongst neurologists, vascular surgeons and interventional radiologists...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Sciendo
2013-03-01
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| Series: | Journal of Ultrasonography |
| Subjects: | |
| Online Access: | http://jultrason.pl/index.php/issues/volume-13-no-52/management-of-carotid-stenosis-history-and-today?aid=114 |
| Summary: | Internal carotid stenosis constitutes a significant clinical challenge, since it is the cause
of 20–25% of ischemic brain strokes. The management of the internal carotid stenosis
for many years has been raising controversies amongst neurologists, vascular surgeons
and interventional radiologists mainly due to the introduction of endovascular stenting
as an alternative to surgical treatment. Its application, however, requires knowledge of
specific selection criteria for this kind of treatment as well as of the methods of monitoring
patients after stent implantation into the internal carotid artery. Duplex Doppler
ultrasound examination is currently a basis for the diagnosis of the arterial stenosis of
precranial segments of the carotid arteries. It allows a reliable assessment of not only
the course and morphology of the walls, but also of the hemodynamics of blood flow.
Interventional treatment is applicable in patients with internal carotid stenosis of ≥70%,
which is accompanied by an increase of the systolic flow velocity above 200 cm/s and
the end-diastolic velocity above 50–60 cm/s in the stenotic lumen. In most cases, such
a diagnosis in duplex Doppler ultrasound examination does not require any confirmation
by additional diagnostic methods and if neurological symptoms are also present, it
constitutes a single indication for interventional treatment. When deciding about choice
of surgical or endovascular method of treatment, the following factors are of crucial
importance: morphology of atherosclerotic plaque, its size, echogenicity, homogeneity
of its structure, its surface and outlines. By means of ultrasound examinations, patients
can be monitored after endovascular stent implantation. They enable evaluation of the
degree of stent patency and allow for an early detection of symptoms indicating stenosis
recurrence or presence of in-stent thrombosis. When interpreting the findings of the US
checkup, it is essential to refer to the initial examination performed in the first days after
the procedure and the next ones conducted during the monitoring period. |
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| ISSN: | 2084-8404 2451-070X |