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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Ultrason
2013 ; 13
(52
): 6-20
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Management of carotid stenosis History and today
#MMPMID26675711
Szczerbo-Trojanowska M
; Jargie??o T
; Drelich-Zbroja A
J Ultrason
2013[Mar]; 13
(52
): 6-20
PMID26675711
show ga
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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