Lucatelli Pierleone, Fanelli Fabrizio, Cirelli Carlo, Sacconi Beatrice, Anzidei Michele, Montisci Roberto, Sanfilippo Roberto, Tamponi Elisabetta, Catalano Carlo, Saba Luca
Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy,
Int J Cardiovasc Imaging. 2015 Apr;31(4):773-81. doi: 10.1007/s10554-015-0623-0. Epub 2015 Feb 20.
To assess potential hemodynamic differences after carotid endarterectomy (CEA) and carotid artery stenting (CAS) and their eventual impact on clinical management. Between July 2012 and October 2013 two groups of 30 patients each referred for CEA or CAS were prospectively enrolled in two tertiary hospital care centers. Pre-procedural imaging assessment of carotid artery disease was performed with Echo-Color-Doppler (ECD) and computed tomography angiography (CTA). ECD was repeated within 24 h and 1, 6 and 12 months after surgical/endovascular procedures. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were assessed at two standard sites: common carotid artery (CCA) and distal internal carotid artery (ICA). Twenty-four hours ECD findings highly differ between the two populations. CCA PSV in the CEA and CAS groups was respectively 44.88 ± 9.16 and 69.20 ± 20.04 cm/s (p = 0.002); CCA EDV was 16.11 ± 2.29 and 19.13 ± 6.42 cm/s (p = 0.065); ICA PSV was 46.11 ± 7.9 and 94.02 ± 57.7 cm/s (p = 0.0012); ICA EDV was 20.22 ± 4.33 and 30.47 ± 18.33 cm/s (p = 0.025). One month, 6 months and 1 year findings confirmed the different trend in the two cohorts; in particular, at 1 year: CCA PSV was 50.94 ± 12.44 and 60.59 ± 26.84 cm/s (p = 0.181); CCA EDV was 17.11 ± 3.46 and 19 ± 16.35 cm/s (p = 0.634); ICA PSV was 51.66 ± 10.1 and 70.86 ± 20.64 cm/s (p = 0.014); ICA EDV was 25.05 ± 8.65 and 32.66 ± 13 cm/s (p = 0.0609). ECD follow-up of patients undergone CEA or CAS may play a critical role in the clinical management. Strict surveillance of blood flow velocities allows reducing false positive re-stenosis diagnosis and choosing the best anti-aggregation therapies. Within the first month CEA patients benefit from a lower risk condition in comparison with CAS patients, due to a significantly faster PSV drop; moreover, long-term CCA PSV after CEA could be used as a surrogate marker of neointima formation.
评估颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）后潜在的血流动力学差异及其对临床管理的最终影响。在2012年7月至2013年10月期间，两组各30例因CEA或CAS前来就诊的患者被前瞻性纳入两家三级医院护理中心。采用超声彩色多普勒（ECD）和计算机断层血管造影（CTA）对颈动脉疾病进行术前影像学评估。在手术/血管内介入术后24小时、1个月、6个月和12个月内重复进行ECD检查。在两个标准部位评估收缩期峰值流速（PSV）和舒张末期流速（EDV）：颈总动脉（CCA）和颈内动脉远端（ICA）。两组患者术后24小时的ECD检查结果差异显著。CEA组和CAS组的CCA PSV分别为44.88±9.16和69.20±20.04cm/s（p = 0.002）；CCA EDV分别为16.11±2.29和19.13±6.42cm/s（p = 0.065）；ICA PSV分别为46.11±7.9和94.02±57.7cm/s（p = 0.0012）；ICA EDV分别为20.22±4.33和30.47±18.33cm/s（p = 0.025）。1个月、6个月和1年的检查结果证实了两组的不同趋势；特别是在1年时：CCA PSV分别为50.94±12.44和60.59±26.84cm/s（p = 0.181）；CCA EDV分别为17.11±3.46和19±16.35cm/s（p = 0.634）；ICA PSV分别为51.66±10.1和70.86±20.64cm/s（p = 0.014）；ICA EDV分别为25.05±8.65和32.66±13cm/s（p = 0.0609）。对接受CEA或CAS治疗的患者进行ECD随访可能在临床管理中发挥关键作用。严格监测血流速度有助于减少假阳性再狭窄诊断，并选择最佳的抗聚集治疗方案。在第一个月内，与CAS患者相比，CEA患者受益于较低的风险状况，这是因为PSV下降明显更快；此外，CEA术后长期的CCA PSV可作为新生内膜形成的替代标志物。
