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As if this weren't all complicated enough! One more interesting thing that is emerging in the literature with the new generation(s) of drug-eluting stents may work too well, that is they may prevent the formation of any neointimal lining. I have seen a few isolated reports of stents more than a year out that are completely void of any intimal, ie: still bare metal inside the artery. This would seem problematic to me......... I agree with Jean - we clearly do not know much about this - perhaps we simply need to be smarter! Bill Schroedter Venice, Fl -----Original Message----- From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Jean Primozich Sent: Wednesday, October 12, 2005 5:12 PM To: [log in to unmask] Subject: Re: Carotid Stent Follow up Gail, Because we do not yet know the natural history of carotid stents, and because I believe that there is much to learn about what happens to these arteries after they are stented, I think that follow up should be done more often than with carotid endarterectomy; perhaps every 3 months, until we have some hard data to show that the vessels respond in the same manner as we espect after endartectomy. The first follow up post op study should be within one month after the procedure and bilateral, so as to see if the contralateral side has changed (decrease flow) due to the elimination of the stenosis on the procedure side. (Just like with carotid endarterectomy). This should serve as a baseline scan, at least for the stented artery, and all other follow up studies should be compared to this study. Since we do not know what the normal velocity is within a stent or whether it is elevated for reasons not yet defined, we must keep in mind that this is not a "normal" vessel any longer. It has scaffolding, i.e. the stent, making the walls potentially stiffer and it has basically created a theoretical uniform flow channel without a bulb. It has also been ballooned (perhaps more than once) and has a metal structure against the walls potentially causing prolonged inflammation and therefore potential restenosis. We just don't know the answers yet. Which is why why we have to be very careful about using criteria that we use for native unstented arteries and criteria that was not validated according to the NASCET method, that is using the distal ICA as reference. The old criteria that used the bulb as the reference, probably should not be used with any confidence for any studies (stented or not) that we do these days, since all of the angiograms are now being standardly read using the distal ICA as reference. I have included two references for criteria that I think look pretty good, although bear in mind, these are small studies and have not been tested prospectively or reproduced in other centers. But, nonetheless, the velocities look like what I might think would be legitimate (hemodynamically) in a stented vessels. I would be willing to discuss this in more detail if you would like, perhaps on the phone. Give me a call (206) 685-3225. References: Stanziale, SF, et al. Determining in-stent stenosis of carotid arteries by duplex ultrasound. J Endovasc Ther. Jun; 12(3), 2005. Lai BK, Hobson RW, Goldstein J, et al. Carotid artery stenting:is there a need to revise ultrasound velocity criteria?. J Vasc Surg, 2004;39. Hope this helps, Jean Primozich University of Washington Ø ----- Original Message ----- From: "Anna Marie Kupinski" <[log in to unmask]> To: <[log in to unmask]> Sent: Wednesday, October 12, 2005 5:59 AM Subject: Re: Carotid Stent Follow up > Hi Gail, > > We usually scan them prior to discharge or at the first post-procedure > office visit. Then usually every 6 months. The only criteria we have > is what we currently use for the native carotid vessels. However, our > velocities tend to be higher so our lower cut off was raised from 125 to > 150 cm/s. > > Ann Marie > > Ann Marie Kupinski, PhD RVT > Technical Director, Karmody Vascular Laboratory > The Vascular Group, PLLC > Albany, NY 12208 > phone:518-262-5050 > fax:518-262-6686 > >>>> [log in to unmask] 10/11/2005 7:47:52 PM >>> > > Need some help. Can someone tell me what the usually carotid stent > surveillance protocol is and what criterias are being used -- Bandyk? > Jeannie, Anne Marie... Thanks > > > Gail P. Size, BS, RVT, RVS, RCVT > Educational Coordinator > www.VASCULAR-WEB.COM > A Resource for Vascular Professionals > Western Office > 13303 S. Desert Dawn Dr. > Pearce, AZ 856252 > Phone 520-642-1303 Fax 520-642-1304 > > > > To unsubscribe or search other topics on UVM Flownet link to: > http://list.uvm.edu/archives/uvmflownet.html > > > To unsubscribe or search other topics on UVM Flownet link to: > http://list.uvm.edu/archives/uvmflownet.html > To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html