Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Surgery, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
PLoS One. 2020 Dec 29;15(12):e0244544. doi: 10.1371/journal.pone.0244544. eCollection 2020.
This study aimed to describe the duplex ultrasound (DUS) findings associated with carotid restenosis after carotid endarterectomy (CEA) and to determine whether carotid restenosis is associated with the clinical outcomes of CEA. Between January 2007 and December 2016, a total of 660 consecutive patients who underwent 717 CEAs were followed up at our hospital with DUS surveillance for at least 3 years after CEA. These patients were analyzed retrospectively for this study. Following CEA, restenosis was defined as the development of ≥50% stenosis, diagnosed on the basis of DUS findings of the luminal narrowing and velocity criteria. The study outcomes were defined as restenosis of the ipsilateral carotid artery after CEA and late (>30days) fatal or nonfatal stroke ipsilateral to the carotid restenosis. During the median follow-up period of 74 months, the restenosis incidence was 2.8% (20/717), and there were 2 strokes (2/20, 10%) ipsilateral to the restenosis after CEA; reintervention was performed for 11 patients with carotid restenosis (55%). Within 2 years after CEA, restenosis was identified in 9 cases (45%, 9/20), and 8 reinterventions (72.7%, 8/11) were performed. According to DUS findings, the morphologic characteristics of carotid restenosis were different from the preoperative plaque morphology. Among the 20 carotid restenosis cases, we observed the following DUS patterns: homogenous isoechoic restenosis (n = 14, 70%), homogenous hypoechoic (n = 2, 10%), isoechoic with hypoechoic surface (n = 3, 15%), and hypoechoic with isoechoic surface (n = 1, 5%). Although 9 carotid restenosis patients received prophylactic reintervention to mitigate the progression of restenosis, the 2 symptomatic restenosis patients had isoechoic lesions with hypoechoic surfaces on DUS. On Kaplan-Meier survival analyses, in terms of stroke-free survival rates, there was a higher risk of stroke among patients with carotid restenosis compared with patients without restenosis, with a non-significant trend (P = 0.051). In conclusion, most carotid restenoses were identified within 2 years after CEA, and there was a non-significant trend toward a higher risk of stroke among patients with carotid restenosis.
本研究旨在描述颈动脉内膜切除术（CEA）后颈动脉再狭窄的双功能超声（DUS）表现，并确定颈动脉再狭窄是否与 CEA 的临床结果相关。2007 年 1 月至 2016 年 12 月，我院对 660 例连续行 717 例 CEA 的患者进行了 DUS 监测随访，随访时间至少 3 年。对这些患者进行了回顾性分析。CEA 后，再狭窄定义为根据管腔狭窄和速度标准的 DUS 检查发现≥50%狭窄。本研究的结局定义为 CEA 后同侧颈动脉再狭窄和同侧颈动脉再狭窄后（>30 天）迟发性（>30 天）致命或非致命性卒中。在中位随访 74 个月期间，再狭窄发生率为 2.8%（20/717），再狭窄后同侧发生 2 例卒（2/20，10%）；对 20 例颈动脉再狭窄患者中的 11 例（55%）进行了再次干预。CEA 后 2 年内发现再狭窄 9 例（45%，9/20），8 例（72.7%，8/11）进行了再干预。根据 DUS 检查结果，颈动脉再狭窄的形态特征与术前斑块形态不同。在 20 例颈动脉再狭窄病例中，我们观察到以下 DUS 模式：等回声均匀再狭窄（n=14，70%）、低回声均匀（n=2，10%）、等回声伴低回声表面（n=3，15%）和低回声伴等回声表面（n=1，5%）。尽管 9 例颈动脉再狭窄患者接受了预防性再次干预以减轻再狭窄的进展，但 2 例症状性再狭窄患者的 DUS 上有等回声伴低回声表面的病变。在 Kaplan-Meier 生存分析中，就无卒中生存率而言，再狭窄患者的卒中风险较高，但无显著趋势（P=0.051）。总之，大多数颈动脉再狭窄发生在 CEA 后 2 年内，再狭窄患者的卒中风险有升高趋势，但无统计学意义。
