After
a successful CAS, a stringent monitoring of cardiovascular risk factors seems to be essential. Not only with regard to primary and secondary stroke prevention, but also especially in the context of ISR development, several publications SGI-1776 in vitro show a correlation between the presence of cardiovascular risk factors, such as tobacco use [17] and [42], diabetes mellitus [18] and [22], e.g. represented by an elevated HbA1c [36], low HDL cholesterol [26], and the occurrence of an ISR. ISR after CAS is frequently observed within the first year of follow-up and might be associated with a higher risk for clinical complications. Against the light that a CAS intervention is frequently recommended as an alternative treatment strategy to CEA especially in patients aged <70 years, a tight and long-lasting PFT�� follow-up is warranted. Particularly patients who are of advanced age, treated
for a radiogenic stenosis or a recurrent stenosis after CEA, or with the presence of cardiovascular risk factors such as tobacco use, diabetes mellitus or a dyslipoproteinemia or certain procedure-related factors (a narrow or long stent, insufficient stent adaptation after CAS or the use of multiple stents) are prone to develop an ISR. A significant heterogeneity especially regarding the exact duplex criteria to identify an ISR has been observed between the reviewed studies thus supporting the need to establish commonly accepted criteria for ISR-grading. With respect to the possible clinical relevance of an ISR and a lacking commonly accepted treatment strategy, all efforts should be made to carefully follow-up especially those patient subgroups at risk for ISR in order to see more further develop
an optimized treatment strategy. “
“Carotid stenting is an accepted form of revascularization in the US and many countries based on the recent results of the CREST trial [1]. The choice of follow-up imaging remains variable for post-stent patients and some patients receiving no post-stent imaging. Ultrasound imaging is a cost effective and simple way to evaluate immediate post-stent patients. We retrospectively reviewed a database for a 2 year period from 2008 to 2010 for patients who had significant carotid stenosis and underwent carotid stenting, and post-stent carotid ultrasound exam. In stent velocities were measured with a General Electric LOGIQ E9 (Milwaukee, WI) with 9 MHz linear probe that was used to evaluate the post stent carotid artery. Forty-five patients (age between 43 and 75 years) were identified, who received post stent ultrasound. We found a mean peak systolic velocity of 83 cm/s and a mean end diastolic velocity of 24 cm/s in this population, with a range peak systolic velocity 33–150 cm/s and end diastolic velocity 11–52 cm/s.