Seminars in Vascular Surgery最新文献

{"title":"Contemporary use of ultrasound for diagnosis and surveillance of carotid stenosis","authors":"Aravind S Ponukumati,&nbsp;Jennifer A Stableford","doi":"10.1053/j.semvascsurg.2026.01.004","DOIUrl":"10.1053/j.semvascsurg.2026.01.004","url":null,"abstract":"<div><div>Carotid duplex ultrasound emerged in the 1970s, and in the subsequent decade it leapt rapidly from the bench to the bedside. While duplex velocity criteria were initially validated against carotid angiograms with good fidelity, the methods of measurement employed by pivotal carotid trials in the 1990s necessitated a revalidation of existing classification schemes. Today, there is significant variation in the criteria used by vascular laboratories, with early efforts towards standardization correlating poorly with other imaging modalities. The new Intersocietal Accreditation Commission modified consensus criteria revised in 2023 represent the newest effort to standardize duplex criteria based on traditional as well as more clinically relevant metrics. In the modern era, duplex ultrasound has shown benefit in screening asymptomatic groups at high risk for carotid stenosis such as those with numerous atherosclerotic risk factors, high-risk patients undergoing coronary artery bypass grafting, and those with lower extremity peripheral arterial disease. Carotid duplex also serves as a practical method of surveilling patients for restenosis after carotid endarterectomy and carotid artery stenting, with recent studies guiding modified velocity criteria in this population. Characterization of plaque morphology continues to evolve and may predict plaques at high risk of becoming symptomatic, and those which may respond poorly to carotid stenting. Even with the emergence of higher spatial resolution modalities such as CT and MR angiography, carotid duplex continues to play a critical role in the current diagnosis and treatment of carotid disease.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 22-33"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared decision-making and the use of decision aids in the management of carotid disease","authors":"Brianna M. Krafcik ,&nbsp;Kelsey Eklund ,&nbsp;Bryan Wallace ,&nbsp;Dominic N. Facciponte ,&nbsp;Bjoern D. Suckow ,&nbsp;David H. Stone ,&nbsp;Philip P. Goodney","doi":"10.1053/j.semvascsurg.2025.12.001","DOIUrl":"10.1053/j.semvascsurg.2025.12.001","url":null,"abstract":"<div><div>Changes to the National Coverage Determination for carotid stenting now mandates a documented shared decision-making (SDM) interaction between the provider and patient as a prerequisite for reimbursement. Historically, formalized SDM tools to facilitate these discussions have been underutilized in clinical practice among vascular surgeons. Therefore, our objective was to conduct a contemporary review of currently available information surrounding SDM and decision support instruments for patients with carotid disease. To do this, we performed a review of the literature for publications related to SDM or decision aid development for patients with carotid artery disease. Eight studies met inclusion criteria. We determined that patients with carotid disease generally preferred to take an active role in the decision-making process. Factors such as patient understanding of their disease and perceived benefit of the therapy can impact SDM discussions and the ultimate therapeutic decision. The decision aid information and corresponding visual format can influence patient understanding and choice. Furthermore, research describing any SDM and patient preferences regarding transcarotid artery revascularization is lacking. Accordingly, continued development of a disease-specific validated decision aid for patients with carotid stenosis will improve SDM discussions and ensure value-based patient decisions.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 58-67"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonoperative management of patients with symptomatic carotid stenosis","authors":"Matthew Yen ,&nbsp;Larry B. Goldstein ,&nbsp;Brian Silver ,&nbsp;Seemant Chaturvedi","doi":"10.1053/j.semvascsurg.2026.01.006","DOIUrl":"10.1053/j.semvascsurg.2026.01.006","url":null,"abstract":"<div><div>The interventional management of symptomatic carotid disease (ie, endarterectomy, angioplasty/stenting, or transcarotid artery revascularization) has traditionally involved correcting the area of arterial narrowing, guided by stenosis severity combined with medical therapy, and has been recommended by the 2021 American Heart Association Secondary Stroke Prevention Guidelines. Despite this traditional practice, advances in medical therapy show promise in reducing recurrent stroke without the need for interventional procedures in the setting of low-to-intermediate-risk carotid lesions. We review current evidence for the nonoperative management of symptomatic carotid disease, focusing on markers of plaque vulnerability, risk calculators, and the efficacy of intensive medical therapy. The objective of this review was to illustrate that medical management of symptomatic carotid disease may be a reasonable alternative to surgical intervention in select patients. High-risk features such as intraplaque hemorrhage, a large lipid-rich necrotic core, a thin fibrous cap, plaque ulceration, vessel wall enhancement, and microembolic activity found on transcranial Doppler ultrasound strongly predict recurrent ischemic events and favor revascularization. In contrast, their absence supports medical management. Risk stratification tools such as the Carotid Artery Risk score and PLAQUE Radiology Scoring system have demonstrated potential utility for identifying low-risk patients who are good candidates for medical therapy. Guideline-directed medical therapy uses antiplatelet agents, intensive lipid-lowering therapy, blood pressure control, diabetes management, and structured lifestyle interventions. Contemporary clinical trials such as the Second European Carotid Surgery Trial and CASCOM are evaluating the comparative effectiveness of revascularization versus intensive medical therapy, with interim data suggesting comparable outcomes in appropriately selected patients. In the modern era, medical management of symptomatic carotid stenosis is safe and effective for patients lacking high-risk plaque features. Integration of imaging biomarkers, validated risk calculators, and structured risk factor modification programs offers a precision-medicine approach that may redefine treatment algorithms and aid in patient management.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 34-40"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Types of carotid stents and their associated strengths and limitations","authors":"Maxime Dubosq-Lebaz ,&nbsp;William A. Gray ,&nbsp;Peter A. Schneider ,&nbsp;Chieh Yang Christopher Koo ,&nbsp;Manon Jouffroy ,&nbsp;Eric A. Secemsky","doi":"10.1053/j.semvascsurg.2025.11.002","DOIUrl":"10.1053/j.semvascsurg.2025.11.002","url":null,"abstract":"<div><div>Carotid artery stenting (CAS) is now established as a less invasive alternative to carotid endarterectomy for patients with carotid artery stenosis. Over the past two decades, stent technologies have undergone significant refinements to improve navigability, conformability, and plaque coverage while aiming to reduce periprocedural complications and enhance long-term durability. Current devices are broadly categorized as open-cell, closed-cell, and dual-layer micromesh stents. Open-cell designs provide excellent flexibility in tortuous anatomy but may be limited by reduced plaque scaffolding. Closed-cell stents improve vessel coverage yet sacrifice some adaptability. Dual-layer micromesh stents combine both principles, seeking to prevent plaque prolapse and distal embolization, with encouraging results from prospective studies and registries. Randomized trials such as CREST and ACT-1 have established the overall noninferiority of CAS compared with carotid endarterectomy, while observational data suggest potential advantages of newer micromesh designs. Nonetheless, clinical outcomes remain closely linked to operator expertise, anatomical complexity, and embolic protection strategies. In contemporary practice, CAS represents a validated treatment option, and individualized stent selection based on device-specific characteristics and patient anatomy is essential to optimize procedural safety and long-term stroke prevention.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 92-100"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcomes and quality of life in carotid revascularization: A narrative review","authors":"Brian Fazzone,&nbsp;Michael J. Fassler,&nbsp;Jonathan Krebs,&nbsp;Perez Agaba,&nbsp;Erik Anderson,&nbsp;Samir K. Shah","doi":"10.1053/j.semvascsurg.2026.01.002","DOIUrl":"10.1053/j.semvascsurg.2026.01.002","url":null,"abstract":"<div><div>Traditional carotid revascularization outcome measures often overlook meaningful changes in outcomes important to patients. Patient-reported outcomes are being used more often to assess how diseases and treatments affect these outcomes, with these insights gathered through patient-reported outcome measures (PROMs). This narrative review summarizes the PROM instruments applied in carotid revascularization studies, highlights key findings regarding quality of life (QoL) before and after intervention, and examines methodological challenges inherent to PROM implementation. Generic PROMs are most often used in carotid revascularization research, with most studies describing QoL changes after carotid endarterectomy in symptomatic patients using the generic 36-Item Short Form Survey PROM. Symptomatic patients can expect a return to baseline QoL by 1 year after intervention. Trial data suggest carotid artery stenting confers a short-term QoL benefit with equivalency to carotid endarterectomy by 1 year. There is insufficient high-quality data to evaluate QoL and revascularization for asymptomatic patients, compare best medical therapy with intervention, or compare the effect of surgical technique on QoL. Interpretation of PROM and QoL data in carotid revascularization research to date is limited by heterogeneity in study methodology and PROM choice and validation. Most PROMs used in carotid revascularization are not validated and lack consensus for testing intervals, patient stratification, and the type of PROM that best reflects patient perceptions. Future work should emphasize the development of carotid disease–specific PROMs to best capture patient-reported outcomes and guide clinical decision making.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 68-74"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Medical Management of Carotid Artery Stenosis","authors":"Maya J. Salameh,&nbsp;Elizabeth V. Ratchford","doi":"10.1053/j.semvascsurg.2026.01.001","DOIUrl":"10.1053/j.semvascsurg.2026.01.001","url":null,"abstract":"<div><div>The prevalence of carotid artery stenosis is expected to increase as the population ages. Patients with carotid disease face an elevated risk of cerebrovascular and cardiovascular (CV) complications, including stroke, transient ischemic attack, myocardial infarction, and CV death. Recommended lifestyle modifications emphasize adherence to a Mediterranean-style diet, regular physical activity, and smoking cessation, with pharmacologic support such as varenicline or combination nicotine replacement therapy as appropriate. Core medical therapies include low-dose aspirin monotherapy (or a P2Y12 receptor antagonist in cases of aspirin allergy or intolerance), high-intensity statin therapy, and blood pressure control. Patients with diabetes should be managed per current guidelines, with preference for SGLT2 inhibitors and GLP-1 receptor agonists due to their CV benefits.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 12-21"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender and racial disparities in the treatment of carotid artery stenosis","authors":"Abby E Rothstein,&nbsp;Kellie R Brown","doi":"10.1053/j.semvascsurg.2026.01.005","DOIUrl":"10.1053/j.semvascsurg.2026.01.005","url":null,"abstract":"<div><div>Carotid disease incidence, prevelence, treatment and outcomes differ by gender and race. This article reviews the available data on outcomes and suggests next steps for research to eliminate these disparities.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 75-81"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction: Staying current on the literature informing best practices for the management of carotid artery stenosis","authors":"Jesse A. Columbo Guest Editor","doi":"10.1053/j.semvascsurg.2026.01.008","DOIUrl":"10.1053/j.semvascsurg.2026.01.008","url":null,"abstract":"","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Page 1"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel radiation-sparing imaging techniques in transcarotid stenting","authors":"Kirthi S. Bellamkonda,&nbsp;William R. Warner,&nbsp;Xiaoyao Fan,&nbsp;Keith Paulsen,&nbsp;Richard J. Powell","doi":"10.1053/j.semvascsurg.2026.01.007","DOIUrl":"10.1053/j.semvascsurg.2026.01.007","url":null,"abstract":"<div><div>Transcarotid artery revascularization is increasingly prevalent, but relies on fluoroscopic guidance for placement of carotid stents. With increasing awareness about the hazards of radiation exposure, we aimed to explore the prior literature regarding alternative and adjunct imaging methods in carotid stenting. These have included fusion with preoperative computed tomography angiography, fully contrast-sparing procedures with preoperative magnetic resonance angiography and fusion using plain fluoroscopy, and ultrasound-assisted transfemoral carotid stenting. All methods demonstrated excellent technical results but have achieved very limited adoption. We also reviewed literature on the use of ultrasound-guided stent and device deployment in other vascular beds, including inferior vena cava (IVC) filter placement, endovascular aneurysm repair, and peripheral arterial stenting, suggesting that ultrasound is a feasible method for intraoperative guidance. However, with lack of widespread adoption, further modifications may be required to improve usability in the operative setting. Finally, our group explored a novel frontier in ultrasound-guided transcarotid stenting, using preoperative computed tomography angiography imaging in conjunction with live ultrasound imaging. Fusion of the live and preoperative imaging allows the user to see the exact location of their ultrasound imaging plane superimposed on a 3-dimensional model of the carotid, taking significant uncertainty out of real-time ultrasound imaging. This novel registration technology may significantly improve the ability of surgeons to use ultrasound in the deployment of carotid stents, thereby reducing radiation exposure in the procedure. In addition, the same technology may be extrapolated to other areas of vascular pathology in the future.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 101-105"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CREST-2: Early reflections on the primary results","authors":"James F. Meschia ,&nbsp;Brajesh Lal ,&nbsp;Thomas Brott","doi":"10.1053/j.semvascsurg.2026.02.002","DOIUrl":"10.1053/j.semvascsurg.2026.02.002","url":null,"abstract":"<div><div>The CREST-2 trial was designed to clarify the contemporary role of carotid revascularization in the management of high-grade asymptomatic carotid stenosis in the setting of increasingly effective medical therapy. Trial execution occurred during a period of rapid evolution in risk-factor management and device technology, raising important questions about how changes in standards of care should influence stroke-prevention strategies. Participants received protocol-driven intensive medical management focused on stringent control of systolic blood pressure and low-density lipoprotein, with adjustments made as guidelines evolved. In the stenting arm, CREST-2 applied rigorous credentialing to ensure procedural expertise. Enrollment was restricted to patients with favorable vascular anatomy and lesion characteristics. Many participants entered the trial with opportunities to improve key vascular risk factors. Obesity and overweight were common among the cohort, and although new weight-loss agents may modify cardiovascular risk profiles, their effects on carotid atherosclerosis remain uncertain. With stringent operator credentialing and selective anatomical eligibility, carotid stenting demonstrated improved periprocedural safety relative to earlier multicenter experiences and effective stroke prevention. Carotid endarterectomy continued to show numerically favorable stroke-prevention outcomes compared with intensive medical management alone, although the observed risk reduction at 4 years did not reach statistical significance. Intensive medical management remains the foundational treatment strategy, yet revascularization retains an important role when performed by experienced operators in appropriately selected patients.</div></div>","PeriodicalId":51153,"journal":{"name":"Seminars in Vascular Surgery","volume":"39 1","pages":"Pages 52-57"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}