Altered in-stent hemodynamics may cause erroneous upgrading of moderate carotid artery restenosis when evaluated by duplex ultrasound

作者：Hakimi Maani^*; Knez Peter; Lippert Matthias; Attigah Nicolas; Nelson Karen; Laub Tanja; Boeckler Dittmar; Schmitz Rixen Thomas; Schmandra Thomas

来源：Journal of Vascular Surgery, 2012, 56(5): 1403-1408.

DOI：10.1016/j.jvs.2012.03.035

Objective: To assess the influence of stent application on in-stent hemodynamics under standardized conditions. %26lt;br%26gt;Methods: Ovine common carotid arteries before and after stent (6 x 40 mm, sinus-Carotid-RXt, combined open-closed cell design; Optimed, Ettlingen, Germany) application were used. Plastic tubes, 10 mm in length, simulating stenosis were placed in the middle of the applied stent to induce different degrees of stenosis (moderate 57.8% and severe 76.4%). Flow velocity and dynamic compliance were, respectively, measured with ultrasound and laser scan; proximal, in-stent, and distal to the stented arterial segment (1 cm proximal and distal) in a pulsatile ex vivo circulation system. %26lt;br%26gt;Results: Stent insertion caused the in-stent peak systolic velocity to increase 22% without stenosis, 31% with moderate stenosis, and 23% with severe stenosis. Stent insertion without stenosis caused no significant increase in in-stent end-diastolic velocity (EDV) but a 17% increase with moderate stenosis. In severe stenosis, EDV was increased 56% proximal to the stenosis. Compliance was reduced threefold in the middle of the stented arterial segment where flow velocity was significantly increased. %26lt;br%26gt;Conclusions: With or without stenosis, stent introduction caused the in-stent peak systolic velocity to become significantly elevated compared with a nonstented area. EDV was also increased by stent insertion in the case of moderate stenosis. The stent-induced compliance reduction may be causal for the increase in flow velocity since the stent-induced flow velocity elevation appeared in the stented area with low compliance. Because of altered hemodynamics caused by stent introduction when measured by duplex ultrasound, caution is prudent in concluding that carotid artery stenting is associated with a higher restenosis rate than carotid endarterectomy. Mistakenly upgrading moderate to severe restenosis could result in unnecessary reintervention. (J Vasc Surg 2012;56:1403-8.)

• 出版日期2012-11