Key result
In patients undergoing staged carotid artery stenting, percutaneous transluminal angioplasty significantly improved stenosis (84.4% to 64.1%, p<0.001) and increased peak systolic velocity when pre-operative PSV was <350 cm/s.
Why the study?
Flow velocity rises with higher carotid stenosis but drops to undetectable levels if occluded, suggesting a turning point that had not been evaluated in actual patients.
Does percutaneous transluminal angioplasty change peak systolic velocity in patients with high carotid artery stenosis undergoing staged carotid artery stenting?
Observational (n=16)
No
Does percutaneous transluminal angioplasty change peak systolic velocity in patients with high carotid artery stenosis undergoing staged carotid artery stenting?
Absolute Event Rate: 64.1% vs 84.4%
p-value: p=<0.001
In patients with highly stenotic carotid arteries undergoing staged stenting, mild improvement of stenosis via PTA can paradoxically increase peak systolic velocity, especially when baseline PSV is <350 cm/s, which should not be misinterpreted as worsening stenosis.
Increases in flow velocity are observed with duplex ultrasonography when carotid artery is highly stenotic. It is very common that NASCET of 70% stenosis often shows peak systolic velocity (PSV) of over 200cm/s. The higher the stenosis, the more PSV increases. However, if the artery is occluded, the velocity cannot be detected. Therefor there should be turning point in flow velocity. There are no previous studies which mention the turning point with actual patients. Sixteen patients who underwent staged carotid artery stenting (CAS) were included to investigate the change of flow velocity using duplex ultrasonography between pre-operation and post percutaneous transluminal angioplasty (PTA). After PTA, all patients showed improvement of their stenosis significantly (84.4 ± 7.3% vs. 64.1 ± 17.2%, p < 0.001). While 8 patients PSV decreased, the other 8 patients PSV increased. In 6 patients who had PSV < 350cm/s with high stenosis, all patients showed increasing PSV after PTA. This study demonstrated that the flow velocity observed with duplex ultrasonography could increase when high stenosis mildly improved, especially in patient with pre-operative PSV < 350cm/s.
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Sadahiro et al. (2019) conducted an observational in High carotid artery stenosis (n=16). Percutaneous transluminal angioplasty (PTA) vs. Pre-operation (baseline) was evaluated on Carotid artery stenosis (NASCET %) (p=<0.001). In patients undergoing staged carotid artery stenting, percutaneous transluminal angioplasty significantly improved stenosis (84.4% to 64.1%, p<0.001) and increased peak systolic velocity when pre-operative PSV was <350 cm/s.
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