Section of Vascular Medicine, Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Mass 02114, USA.
Circ Cardiovasc Interv. 2009 Oct;2(5):438-43. doi: 10.1161/CIRCINTERVENTIONS.109.857276. Epub 2009 Sep 1.
Duplex ultrasonography criteria for assessing the severity of carotid artery (CA) in-stent restenosis are not well established.
We analyzed 39 patients (40 CAs) who underwent CA stenting with baseline and 6-month follow-up carotid duplex ultrasonography and intravascular ultrasound. Intravascular ultrasound measurements included minimum luminal diameter, percent diameter, and lumen area stenosis. Duplex ultrasonography measurements included peak systolic velocity (PSV), percentage change in PSV, end-diastolic velocity (EDV), and internal-to-common CA PSV ratio (ICA/CCA). Receiver operating characteristic curves assessed each duplex measurement to detect >or=50% diameter, >or=75% lumen area stenosis, and minimum luminal diameter <3 mm at follow-up. At 6-month intravascular ultrasound follow-up, >or=50% diameter and >or=75% lumen area CA in-stent restenosis occurred in 20% and 25%, respectively; minimum luminal diameter <3 cm occurred in 48%. Area under receiver operating characteristic curves for PSV, EDV, and ICA/CCA were 0.85, 0.96, and 0.89 for >or=50% diameter stenosis and 0.89, 0.93, and 0.88 for >or=75% lumen area stenosis, respectively. Optimal PSV, EDV, and ICA/CCA criteria to detect >or=50% diameter and >or=75% lumen area CA in-stent restenosis were greater compared with those for native CA. A >98% increase in PSV had the highest specificity, whereas the combination of EDV >41 cm/s and ICA/CCA >2 had the highest sensitivity in detecting >or=75% lumen area CA in-stent restenosis.
PSV, EDV, and ICA/CCA PSV ratio were good discriminators for detecting significant diameter and lumen area greater compared with those for native CA. The combination of duplex velocity criteria increases diagnostic accuracy.
评估颈动脉（CA）支架内再狭窄严重程度的双功能超声标准尚未确立。
我们分析了 39 例（40 例 CA）接受 CA 支架置入术的患者，这些患者在基线和 6 个月时进行了颈动脉双功能超声和血管内超声检查。血管内超声测量包括最小管腔直径、直径百分比和管腔面积狭窄。双功能超声测量包括收缩期峰值速度（PSV）、PSV 百分比变化、舒张末期速度（EDV）和颈内动脉/颈总动脉 PSV 比值（ICA/CCA）。受试者工作特征曲线评估了每种双功能超声测量方法，以检测随访时直径>或=50%、管腔面积>或=75%狭窄和最小管腔直径<3mm。在 6 个月的血管内超声随访中，分别有 20%和 25%的患者发生直径>或=50%和>或=75%的 CA 支架内再狭窄，48%的患者发生最小管腔直径<3cm。PSV、EDV 和 ICA/CCA 的受试者工作特征曲线下面积对于直径>或=50%狭窄分别为 0.85、0.96 和 0.89，对于管腔面积>或=75%狭窄分别为 0.89、0.93 和 0.88。检测直径>或=50%和>或=75%的 CA 支架内再狭窄的最佳 PSV、EDV 和 ICA/CCA 标准与检测天然 CA 的标准相比更大。PSV 增加>98%具有最高的特异性，而 EDV>41cm/s 和 ICA/CCA>2 的组合在检测>或=75%的 CA 支架内再狭窄的管腔面积方面具有最高的敏感性。
PSV、EDV 和 ICA/CCA PSV 比值是检测与天然 CA 相比具有显著直径和管腔面积狭窄的良好鉴别指标。双功能超声速度标准的组合可提高诊断准确性。
