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Changes in Contralateral Peak Systolic Velocity After Carotid Endarterectomy and Carotid Artery Stenting
Jeffrey Indes, MD, Victoria Greenwood, BS, Rafael Vissepo, BS, Adam Cloud, MD, James Menzoian, MD.
University of Connecticut, Farmington, CT, USA.

OBJECTIVE: To evaluate the changes in the peak systolic flow velocity (PSV) in the internal carotid artery (ICA) contralateral to an index carotid artery stenosis that has been treated with either carotid endarterectomy (CEA) or carotid artery stent placement (CAS). We have noted that in some patients the contralateral PSV drops significantly after treatment of the index ICA stenosis either by CEA or CAS. This finding could be of value in patients in whom a second procedure was planned for the contralateral ICA.
METHODS: Carotid duplex evaluations were done on 325 patients who underwent either CEA or CAS procedures at 6 mos post procedure. Relevant clinical information was collected prospectively in a registry. Statistical analysis was done using regression analysis.
RESULTS: There were 203 CEA and 122 CAS procedures. The CEA patients had the following characteristics: 60%% male, 43% with diabetes, 70% smokers, 82% with hypertension,62% with CAD and 55% were symptomatic and the mean age was 69.8. The CAS patients were 63% male, 30% with diabetes, 54%% were smokers, 84% with hypertension, 59% with CAD and 29% were symptomatic and the mean age was 73.3. (ns) The change in contralateral PSV was calculated as a % of the pre-operative value. The range in % drop in PSV was 0-85%. We arbitrarily defined a significant drop in PSV as a >10% change from the pre-operative value. Of the total 325 patients there were 157 patients in this group (48.3%). There were 44 patients in whom the drop in PSV was felt to be clinically significant since it put them in a different category of carotid stenosis (28%).Building a stepwise model using % change as the dependent variable we were not able to demonstrate significance of any of the independent variables predicting the post procedural drop in PSV.
CONCLUSIONS: A significant number of patients will have a clinically relevant drop in PSV in the contralateral ICA following CEA or CAS which could result in a subsequent unnecessary intervention. We suggest duplex evaluation of all patients prior to a contralateral CEA or CAS procedure.

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