Release date: 2007-08-13
Ultrasound plays a critical role in the management of carotid endarterectomy (CEA), especially in reducing the risk of stroke and improving patient outcomes. Carotid stenosis is a major cause of ischemic cerebrovascular disease, with approximately 70% of stroke patients over 60 years old in the U.S. showing signs of carotid atherosclerosis. This condition significantly increases the risk of stroke, making early detection and intervention essential. In our hospital, we were among the first in China to perform both CEA and carotid stenting (CAS), achieving excellent results. Clinical data demonstrate that CEA effectively restores carotid patency, improves cerebral blood flow, and eliminates microembolic sources, making it a key procedure for preventing and treating ischemic stroke.
Historically, digital subtraction angiography (DSA) has been the gold standard for diagnosing carotid stenosis, but it carries risks such as plaque dislodgement and complications like cerebral vasospasm. With advancements in ultrasound technology, particularly in cranial vascular imaging, ultrasound has become a reliable alternative for detecting extracranial carotid artery disease. It is now widely used for screening, intraoperative monitoring, and postoperative follow-up. Studies suggest that using ultrasound alone can reduce surgical risks by half, making CEA more beneficial than medical therapy in many cases.
Before CEA, two-dimensional color Doppler ultrasound (2D-CDUS) is crucial for assessing carotid stenosis. It provides detailed information about plaque characteristics, lumen size, and hemodynamics. Ultrasound helps determine the need for surgery, guide timing, and prevent cerebral ischemia during occlusion. Techniques such as the morphological index and hemodynamic parameters are used to estimate stenosis severity. The area method is particularly useful for irregular plaques, offering high accuracy. Research shows that ultrasound is highly specific for identifying patients with stenosis >70%, who are typically eligible for CEA.
During CEA, real-time ultrasound monitoring helps detect residual stenosis or embolic events. Transcranial color Doppler (TCCD) is also valuable for evaluating intracranial hemodynamics and detecting microemboli. TCD monitoring during surgery can predict stroke risk based on changes in middle cerebral artery flow velocity. Studies show that TCD-guided interventions can reduce postoperative stroke rates from 7% to 2%. However, TCD has limitations in spatial resolution compared to 2D-CDUS, which offers better localization and accuracy.
After CEA, ultrasound remains vital for monitoring complications such as pseudoaneurysms, hematoma, thrombosis, and restenosis. 2D-CDUS can detect pseudoaneurysms by showing cystic masses with no normal arterial layers and abnormal color flow patterns. Hematomas appear as non-pulsatile masses without blood flow signals. Postoperative restenosis is common, with intimal hyperplasia occurring within two years and atherosclerotic recurrence after that. Regular ultrasound follow-ups at 1, 3, 6, and 12 months help identify early signs of restenosis, such as increased systolic velocity and waveform changes.
With ongoing advancements in ultrasound technology, including three-dimensional imaging and contrast-enhanced techniques, the accuracy of carotid assessments will continue to improve. These innovations will further enhance the safety and effectiveness of CEA, reducing stroke and restenosis rates. As a result, ultrasound remains an indispensable tool in the comprehensive care of patients undergoing carotid procedures. —Midi Medical Network
Disposable Plastic Aprons,Plastic Aprons,Disposable Aprons,Disposable Polythene Aprons
Surgimed Medical Supplies Co.,Ltd , https://www.surgimedcn.com