Duplex ultrasound velocity criteria for carotid stenting patients

Abstract

Stroke is the third leading cause of death in the United States with over 783,000 strokes reported annually.1 Over one-third of patients die and another one-third are severely disabled. The annual economic cost exceeds $30 billion.2 Randomized trials have established the efficacy of carotid endarterectomy (CEA) in the prevention of stroke for patients with high-grade carotid stenosis (CS).3-7 The advent of newer technologies and a desire for less invasive treatment have encouraged investigators to propose carotid artery stenting (CAS) as an alternative to CEA.1,8-10 Our institution1, 8,11-17 (Figure 13-1), along with others, 18-22 has demonstrated that CAS is technically feasible and safe in patients with restenosis after CEA, surgically inaccessible lesions, previous radiation, or significant medical comorbidities. The 30-day stroke and death rate in 190 CAS procedures at our institution was 4.15%, indicating a competitive alternative to CEA.14 However, due to the proven efficacy of CEA, current indications for CAS have been limited to situations where CEA yields suboptimal results.13,23 © 2007 Springer-Verlag London Limited.