eprintid: 98874 rev_number: 46 eprint_status: archive userid: 608 dir: disk0/00/09/88/74 datestamp: 2010-10-19 16:35:33 lastmod: 2021-09-26 22:30:04 status_changed: 2010-10-19 16:35:33 type: article metadata_visibility: show item_issues_count: 0 creators_name: Nederkoorn, PJ creators_name: Brown, MM title: Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries: Review and protocol for a diagnostic study ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D07 keywords: VELOCITY CRITERIA, STENOSIS, ENDARTERECTOMY, ANGIOGRAPHY, ULTRASONOGRAPHY, ANGIOPLASTY, ACCURACY, DISEASE, TRIALS, NEED note: © 2009 Nederkoorn and Brown; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. abstract: Background: Carotid angioplasty with stenting is a relatively new, increasingly used, less-invasive treatment for the treatment of symptomatic carotid artery stenosis. It is being evaluated in ongoing and nearly finished randomized trials. An important factor in the evaluation of stents is the occurrence of in-stent restenosis. An un-stented carotid artery is likely to have a more elastic vessel wall than a stented one, even if stenosis is present. Therefore, duplex ultrasound cut-off criteria for the degrees of an in-stent stenosis, based on blood velocity parameters, are probably different from the established cut-offs used for un-stented arteries. Routine criteria can not be applied to stented arteries but new criteria need to be established for this particular purpose. Methods/Design: Current literature was systematically reviewed. From the selected studies, the following data were extracted: publication year, population size, whether the study was prospective, which reference test was used, and if there was an indication for selection bias and for verification bias in particular. Previous studies often were retrospective, or the reference test (DSA or CTA) was carried out only when a patient was suspected of having restenosis at DUS, which may result in verification bias. Results: In general, the cut-off values are higher than those reported for unstented arteries. Previous studies often were retrospective, or the reference test (DSA or CTA) was carried out only when a patient was suspected of having restenosis at DUS, which may result in verification bias. Discussion: To address the deficiencies of the existing studies, we propose a prospective cohort study nested within the International Carotid Stenting Study (ICSS), an international multi-centre trial in which over 1,700 patients have been randomised between stenting and CEA. In this cohort we will enrol a minimum of 300 patients treated with a stent. All patients undergo regular DUS examination at the yearly follow-up visit according to the ICSS protocol. To avoid verification bias, an additional computed tomography angiography (CTA) will be performed as a reference test in all consecutive patients, regardless of the degree of stenosis on the initial DUS test. date: 2009-07-22 publisher: BIOMED CENTRAL LTD official_url: http://dx.doi.org/10.1186/1471-2377-9-36 vfaculties: VFBRS oa_status: green language: eng primo: open primo_central: open_green article_type_text: Review verified: verified_batch elements_source: Web of Science elements_id: 125994 doi: 10.1186/1471-2377-9-36 language_elements: EN lyricists_name: Brown, Martin lyricists_id: MMBRO52 full_text_status: public publication: BMC Neurology volume: 9 article_number: 36 issn: 1471-2377 citation: Nederkoorn, PJ; Brown, MM; (2009) Optimal cut-off criteria for duplex ultrasound for the diagnosis of restenosis in stented carotid arteries: Review and protocol for a diagnostic study. BMC Neurology , 9 , Article 36. 10.1186/1471-2377-9-36 <https://doi.org/10.1186/1471-2377-9-36>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/98874/1/1471-2377-9-36.pdf