title: Interprocedural comparison of changes in natural flow velocity patterns in the internal carotid artery following CAS or CEA.
abstract: OBJECTIVE
  Different flow velocities have been reported after carotid angioplasty with stenting (CAS) than after carotid endarterectomy (CEA). We compared blood flow velocities following CAS and CEA in the International Carotid Stenting Study (ICSS; ISRCTN25337470).
  
  
  METHODS
  In total, 254 patients (70% male; 129 CAS and 125 CEA) were included. Mean peak systolic velocities (PSVICA) were assessed at baseline, 30 days, 1 and 2 years. Following both treatments, restenosis ≥ 50% was defined as PSVmean >125 cm s(-1).
  
  
  RESULTS
  CAS and CEA resulted in a similar reduction in PSVICA 1 month after treatment. Post-intervention analysis for each treatment separately revealed that PSVICA following CAS increased significantly during follow-up (30 days to 2 years; 22.4 cm s(-1); 95% confidence interval (CI), 14.3 to 30.5). On the contrary, PSVICA following CEA remained relatively stable during follow-up (4.7 cm s(-1); 95% CI, -6.5 to 15.9). When we analysed the increase in PSVICA between both treatments after 2 years of follow-up, no significant interprocedural difference was observed. The internal carotid artery/common carotid artery (ICA/CCA) PSV ratio increased after CAS but not after CEA: 1.2 vs. 1.1 (0.04, 95% CI; -0.16 to 0.25) at 30 days; 1.5 vs. 1.1 (0.39, 95% CI; 0.13 to 0.65) at 1 year; and 1.5 vs. 1.1 (0.36; 95% CI, 0.08 to 0.63) at 2 years. The rate of apparent ipsilateral ICA restenosis >50% was higher following CAS (hazard ratio 2.35; 95% CI, 1.35 to 4.09).
  
  
  CONCLUSIONS
  Two years after carotid revascularisation, no significant interprocedural difference was observed in the increase of PSVICA between CAS and CEA. However, the ICA/CCA ratio increased more following CAS resulting in an apparent higher rate of restenosis following CAS.
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: B L
authors.initials: BL
authors.lastname: Reichmann
authors.forename: W E
authors.initials: WE
authors.lastname: Hellings
authors.forename: H B
authors.initials: HB
authors.lastname: van der Worp
authors.forename: P J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.forename: A
authors.initials: A
authors.lastname: Algra
authors.forename: M M
authors.initials: MM
authors.lastname: Brown
authors.forename: F L
authors.initials: FL
authors.lastname: Moll
authors.forename: W P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: G J
authors.initials: GJ
authors.lastname: de Borst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D001783:Blood Flow Velocity; D002343:Carotid Artery, Internal / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016016:Proportional Hazards Models; D012008:Recurrence; D012039:Regional Blood Flow; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome