Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%

Todd D. Lovelace, Gregory (Greg) Moneta, Ahmed M. Abou-Zamzam, James Edwards, Richard A. Yeager, Gregory Landry, Lloyd M. Taylor, John M. Porter

    Research output: Contribution to journalArticle

    24 Citations (Scopus)

    Abstract

    Objectives: The Asymptomatic Carotid Atherosclerosis Study established benefit of carotid endarterectomy for 60% to 99% asymptomatic internal carotid artery (ICA) stenosis. Optimal follow-up intervals to detect progression from <60% to 60%-99% ICA stenosis are unknown. In a previous study from our laboratory, we found that ICAs with <60% stenosis and peak systolic velocities (PSVs) of 175 cm/s or more on initial duplex were at high risk for progression. Prospective evaluation of this hypothesis and determination of optimal duplex follow-up intervals for asymptomatic patients with <60% ICA stenosis form the basis of this report. Methods: All patients who underwent initial carotid duplex examination for any indication since January 1, 1995, with at least one patent, asymptomatic, previously nonoperated ICA with <60% stenosis; with 6 months' or greater follow-up; and with one or more repeat duplex examinations were entered into the study. On the basis of the initial duplex examination, ICAs were classified into two groups: those with a PSV less than 175 cm/s and those with a PSV of 175 cm/s or more. Follow-up duplex examinations were performed at varying intervals to detect progression from <60% to 60%-99% ICA stenosis with criteria previously reported (both PSV ≥ 260 cm/s and end-diastolic velocity ≥ 70 cm/s). Results: A total of 407 patients (640 asymptomatic ICAs with <60% stenosis) underwent serial duplex scans (mean follow-up, 22 months). Three ICAs (0.5%) became symptomatic and progressed to 60%-99% ICA stenosis at a mean of 21 months (all transient ischemic attacks), whereas four other ICAs occluded without stroke during follow-up. Progression to 60%-99% stenosis without symptoms was detected in 46 ICAs (7%) (mean, 18 months). Of the 633 patent asymptomatic arteries, 548 ICAs (87%) had initial PSVs less than 175 cm/s, and 85 ICAs (13%) had initial PSVs of 175 cm/s or more. Asymptomatic progression to 60%-99% ICA stenosis occurred in 22 (26%) of 85 ICAs with initial PSVs of 175 cm/s or more, whereas 24 (4%) of 548 ICAs with initial PSVs less than 175 cm/s progressed (P <.0001). The Kaplan-Meier method was used to determine freedom from progression at 6 months, 12 months, and 24 months, which was 95%, 83%, and 70% for ICAs with initial PSVs of 175 cm/s or more versus 100%, 99%, and 95%, respectively, for ICAs with initial PSVs less than 175 cm/s (P <.0001). Conclusions: Patients with <60% ICA stenosis and PSVs of 175 cm/s or more on initial duplex examination are significantly more likely to progress asymptomatically to 60%-99% ICA stenosis, and progression is sufficiently frequent to warrant follow-up duplex studies at 6-month intervals. Patients with <60% ICA stenosis and initial PSVs less than 175 cm/s may have follow-up duplex examinations safely deferred for 2 years.

    Original languageEnglish (US)
    Pages (from-to)56-61
    Number of pages6
    JournalJournal of Vascular Surgery
    Volume33
    Issue number1
    DOIs
    StatePublished - 2001

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    Carotid Stenosis
    Pathologic Constriction
    Carotid Artery Diseases
    Carotid Endarterectomy
    Transient Ischemic Attack
    Internal Carotid Artery
    Arteries
    Stroke

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%. / Lovelace, Todd D.; Moneta, Gregory (Greg); Abou-Zamzam, Ahmed M.; Edwards, James; Yeager, Richard A.; Landry, Gregory; Taylor, Lloyd M.; Porter, John M.

    In: Journal of Vascular Surgery, Vol. 33, No. 1, 2001, p. 56-61.

    Research output: Contribution to journalArticle

    Lovelace, Todd D. ; Moneta, Gregory (Greg) ; Abou-Zamzam, Ahmed M. ; Edwards, James ; Yeager, Richard A. ; Landry, Gregory ; Taylor, Lloyd M. ; Porter, John M. / Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%. In: Journal of Vascular Surgery. 2001 ; Vol. 33, No. 1. pp. 56-61.
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    title = "Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60{\%}",
    abstract = "Objectives: The Asymptomatic Carotid Atherosclerosis Study established benefit of carotid endarterectomy for 60{\%} to 99{\%} asymptomatic internal carotid artery (ICA) stenosis. Optimal follow-up intervals to detect progression from <60{\%} to 60{\%}-99{\%} ICA stenosis are unknown. In a previous study from our laboratory, we found that ICAs with <60{\%} stenosis and peak systolic velocities (PSVs) of 175 cm/s or more on initial duplex were at high risk for progression. Prospective evaluation of this hypothesis and determination of optimal duplex follow-up intervals for asymptomatic patients with <60{\%} ICA stenosis form the basis of this report. Methods: All patients who underwent initial carotid duplex examination for any indication since January 1, 1995, with at least one patent, asymptomatic, previously nonoperated ICA with <60{\%} stenosis; with 6 months' or greater follow-up; and with one or more repeat duplex examinations were entered into the study. On the basis of the initial duplex examination, ICAs were classified into two groups: those with a PSV less than 175 cm/s and those with a PSV of 175 cm/s or more. Follow-up duplex examinations were performed at varying intervals to detect progression from <60{\%} to 60{\%}-99{\%} ICA stenosis with criteria previously reported (both PSV ≥ 260 cm/s and end-diastolic velocity ≥ 70 cm/s). Results: A total of 407 patients (640 asymptomatic ICAs with <60{\%} stenosis) underwent serial duplex scans (mean follow-up, 22 months). Three ICAs (0.5{\%}) became symptomatic and progressed to 60{\%}-99{\%} ICA stenosis at a mean of 21 months (all transient ischemic attacks), whereas four other ICAs occluded without stroke during follow-up. Progression to 60{\%}-99{\%} stenosis without symptoms was detected in 46 ICAs (7{\%}) (mean, 18 months). Of the 633 patent asymptomatic arteries, 548 ICAs (87{\%}) had initial PSVs less than 175 cm/s, and 85 ICAs (13{\%}) had initial PSVs of 175 cm/s or more. Asymptomatic progression to 60{\%}-99{\%} ICA stenosis occurred in 22 (26{\%}) of 85 ICAs with initial PSVs of 175 cm/s or more, whereas 24 (4{\%}) of 548 ICAs with initial PSVs less than 175 cm/s progressed (P <.0001). The Kaplan-Meier method was used to determine freedom from progression at 6 months, 12 months, and 24 months, which was 95{\%}, 83{\%}, and 70{\%} for ICAs with initial PSVs of 175 cm/s or more versus 100{\%}, 99{\%}, and 95{\%}, respectively, for ICAs with initial PSVs less than 175 cm/s (P <.0001). Conclusions: Patients with <60{\%} ICA stenosis and PSVs of 175 cm/s or more on initial duplex examination are significantly more likely to progress asymptomatically to 60{\%}-99{\%} ICA stenosis, and progression is sufficiently frequent to warrant follow-up duplex studies at 6-month intervals. Patients with <60{\%} ICA stenosis and initial PSVs less than 175 cm/s may have follow-up duplex examinations safely deferred for 2 years.",
    author = "Lovelace, {Todd D.} and Moneta, {Gregory (Greg)} and Abou-Zamzam, {Ahmed M.} and James Edwards and Yeager, {Richard A.} and Gregory Landry and Taylor, {Lloyd M.} and Porter, {John M.}",
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    language = "English (US)",
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    TY - JOUR

    T1 - Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%

    AU - Lovelace, Todd D.

    AU - Moneta, Gregory (Greg)

    AU - Abou-Zamzam, Ahmed M.

    AU - Edwards, James

    AU - Yeager, Richard A.

    AU - Landry, Gregory

    AU - Taylor, Lloyd M.

    AU - Porter, John M.

    PY - 2001

    Y1 - 2001

    N2 - Objectives: The Asymptomatic Carotid Atherosclerosis Study established benefit of carotid endarterectomy for 60% to 99% asymptomatic internal carotid artery (ICA) stenosis. Optimal follow-up intervals to detect progression from <60% to 60%-99% ICA stenosis are unknown. In a previous study from our laboratory, we found that ICAs with <60% stenosis and peak systolic velocities (PSVs) of 175 cm/s or more on initial duplex were at high risk for progression. Prospective evaluation of this hypothesis and determination of optimal duplex follow-up intervals for asymptomatic patients with <60% ICA stenosis form the basis of this report. Methods: All patients who underwent initial carotid duplex examination for any indication since January 1, 1995, with at least one patent, asymptomatic, previously nonoperated ICA with <60% stenosis; with 6 months' or greater follow-up; and with one or more repeat duplex examinations were entered into the study. On the basis of the initial duplex examination, ICAs were classified into two groups: those with a PSV less than 175 cm/s and those with a PSV of 175 cm/s or more. Follow-up duplex examinations were performed at varying intervals to detect progression from <60% to 60%-99% ICA stenosis with criteria previously reported (both PSV ≥ 260 cm/s and end-diastolic velocity ≥ 70 cm/s). Results: A total of 407 patients (640 asymptomatic ICAs with <60% stenosis) underwent serial duplex scans (mean follow-up, 22 months). Three ICAs (0.5%) became symptomatic and progressed to 60%-99% ICA stenosis at a mean of 21 months (all transient ischemic attacks), whereas four other ICAs occluded without stroke during follow-up. Progression to 60%-99% stenosis without symptoms was detected in 46 ICAs (7%) (mean, 18 months). Of the 633 patent asymptomatic arteries, 548 ICAs (87%) had initial PSVs less than 175 cm/s, and 85 ICAs (13%) had initial PSVs of 175 cm/s or more. Asymptomatic progression to 60%-99% ICA stenosis occurred in 22 (26%) of 85 ICAs with initial PSVs of 175 cm/s or more, whereas 24 (4%) of 548 ICAs with initial PSVs less than 175 cm/s progressed (P <.0001). The Kaplan-Meier method was used to determine freedom from progression at 6 months, 12 months, and 24 months, which was 95%, 83%, and 70% for ICAs with initial PSVs of 175 cm/s or more versus 100%, 99%, and 95%, respectively, for ICAs with initial PSVs less than 175 cm/s (P <.0001). Conclusions: Patients with <60% ICA stenosis and PSVs of 175 cm/s or more on initial duplex examination are significantly more likely to progress asymptomatically to 60%-99% ICA stenosis, and progression is sufficiently frequent to warrant follow-up duplex studies at 6-month intervals. Patients with <60% ICA stenosis and initial PSVs less than 175 cm/s may have follow-up duplex examinations safely deferred for 2 years.

    AB - Objectives: The Asymptomatic Carotid Atherosclerosis Study established benefit of carotid endarterectomy for 60% to 99% asymptomatic internal carotid artery (ICA) stenosis. Optimal follow-up intervals to detect progression from <60% to 60%-99% ICA stenosis are unknown. In a previous study from our laboratory, we found that ICAs with <60% stenosis and peak systolic velocities (PSVs) of 175 cm/s or more on initial duplex were at high risk for progression. Prospective evaluation of this hypothesis and determination of optimal duplex follow-up intervals for asymptomatic patients with <60% ICA stenosis form the basis of this report. Methods: All patients who underwent initial carotid duplex examination for any indication since January 1, 1995, with at least one patent, asymptomatic, previously nonoperated ICA with <60% stenosis; with 6 months' or greater follow-up; and with one or more repeat duplex examinations were entered into the study. On the basis of the initial duplex examination, ICAs were classified into two groups: those with a PSV less than 175 cm/s and those with a PSV of 175 cm/s or more. Follow-up duplex examinations were performed at varying intervals to detect progression from <60% to 60%-99% ICA stenosis with criteria previously reported (both PSV ≥ 260 cm/s and end-diastolic velocity ≥ 70 cm/s). Results: A total of 407 patients (640 asymptomatic ICAs with <60% stenosis) underwent serial duplex scans (mean follow-up, 22 months). Three ICAs (0.5%) became symptomatic and progressed to 60%-99% ICA stenosis at a mean of 21 months (all transient ischemic attacks), whereas four other ICAs occluded without stroke during follow-up. Progression to 60%-99% stenosis without symptoms was detected in 46 ICAs (7%) (mean, 18 months). Of the 633 patent asymptomatic arteries, 548 ICAs (87%) had initial PSVs less than 175 cm/s, and 85 ICAs (13%) had initial PSVs of 175 cm/s or more. Asymptomatic progression to 60%-99% ICA stenosis occurred in 22 (26%) of 85 ICAs with initial PSVs of 175 cm/s or more, whereas 24 (4%) of 548 ICAs with initial PSVs less than 175 cm/s progressed (P <.0001). The Kaplan-Meier method was used to determine freedom from progression at 6 months, 12 months, and 24 months, which was 95%, 83%, and 70% for ICAs with initial PSVs of 175 cm/s or more versus 100%, 99%, and 95%, respectively, for ICAs with initial PSVs less than 175 cm/s (P <.0001). Conclusions: Patients with <60% ICA stenosis and PSVs of 175 cm/s or more on initial duplex examination are significantly more likely to progress asymptomatically to 60%-99% ICA stenosis, and progression is sufficiently frequent to warrant follow-up duplex studies at 6-month intervals. Patients with <60% ICA stenosis and initial PSVs less than 175 cm/s may have follow-up duplex examinations safely deferred for 2 years.

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