PMID- 37657687 OWN - NLM STAT- MEDLINE DCOM- 20231121 LR - 20231124 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 78 IP - 6 DP - 2023 Dec TI - Discrepancies in clavicle-to-carotid bifurcation length measurements for transcarotid artery revascularization using different imaging modalities. PG - 1439-1448.e2 LID - S0741-5214(23)01938-9 [pii] LID - 10.1016/j.jvs.2023.08.124 [doi] AB - OBJECTIVE: Transcarotid artery revascularization (TCAR) has emerged as an effective method for carotid artery stenting. However, anatomic eligibility for TCAR is most often limited by an inadequate clavicle-to-carotid bifurcation length of <5 cm. Preoperative clavicle-to-carotid bifurcation distances may be underestimated when using conventional straight-line measurements on computed tomographic angiography (CTA) imaging. We therefore compared clavicle-to-carotid bifurcation lengths as measured by straight-line CTA, center-line CTA, and intraoperative duplex ultrasound (US), to assess potential differences. METHODS: We conducted a single-center, retrospective review of consecutive TCAR procedures performed between 2016 and 2019 for atherosclerotic carotid disease. For each patient, we compared clavicle-to-carotid bifurcation lengths measured by straight-line CTA, center-line CTA using TeraRecon image reconstruction, and intraoperative duplex US with neck extension and rotation. We further assessed patient and imaging characteristics in individuals with a >/=0.5 cm difference among the measurement methods. In particular, common carotid artery (CCA) tortuosity, defined as the inability to visualize the entire CCA from clavicle to carotid bifurcation on both a single coronal and sagittal imaging cut, was examined as a contributing factor for these discrepancies. RESULTS: Of the 70 TCAR procedures identified, 46 had all three imaging modalities available for review. The median clavicle-to-carotid bifurcation length was found to be 6.4 cm (interquartile range [IQR], 5.4-6.7 cm) on straight-line CTA, 7.0 cm (IQR, 6.0-7.5 cm) on intraoperative duplex US, and 7.2 cm (IQR, 6.5-7.5 cm) on center-line CTA (P < .001). Patients with a >/=0.5 cm difference between their straight-line CTA and either their intraoperative duplex US or center-line CTA measurements were more likely to have tortuous CCAs (60.0% vs 19.1%; P = .01; 51.4% vs 0.0%; P = .01). There were no notable differences in age, gender, prior neck/cervical spine surgery, or neck immobility among these individuals. In patients with tortuous CCAs, duplex US and center-line CTA measurements added 1.0 cm (IQR, 0.6-1.5 cm) and 1.1 cm (IQR, 0.9-1.6 cm) more in length than straight-line CTA measurements, respectively. There was a strong linear correlation between the additional lengths provided by duplex US measurements and those provided by center-line CTA measurements for each individual within the tortuous CCA group (r = 0.83). CONCLUSIONS: The use of straight-line CTA during preoperative planning can underestimate the clavicle-to-carotid bifurcation lengths in patients undergoing carotid revascularization, particularly in those with tortuous CCAs. Both duplex US performed with extended-neck surgical positioning and center-line CTA provide similar and longer carotid length measurements, and should be utilized in patients with tortuous carotid vessels to better determine TCAR anatomic eligibility. CI - Copyright (c) 2023 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Wu, Winona W AU - Wu WW AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Yadavalli, Sai Divya AU - Yadavalli SD AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Lu, Jinny J AU - Lu JJ AD - Division of Vascular and Endovascular Surgery, Harbor-UCLA Medical Center, Los Angeles, CA. FAU - Cheng, Jane J AU - Cheng JJ AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Liang, Patric AU - Liang P AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Dansey, Kirsten AU - Dansey K AD - Division of Vascular and Endovascular Surgery, University of Washington, Seattle, WA. FAU - Stangenberg, Lars AU - Stangenberg L AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Wyers, Mark C AU - Wyers MC AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Hamdan, Allen D AU - Hamdan AD AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. FAU - Schermerhorn, Marc L AU - Schermerhorn ML AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mscherm@bidmc.harvard.edu. LA - eng GR - T32 HL007734/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20230830 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - Congenital contractural arachnodactyly SB - IM MH - Humans MH - *Carotid Stenosis/diagnostic imaging/surgery MH - Clavicle MH - Stents MH - Vascular Surgical Procedures MH - Carotid Artery, Common OTO - NOTNLM OT - CTA OT - Clavicle-to-carotid bifurcation length OT - Duplex ultrasound OT - Transcarotid artery revascularization COIS- Disclosures M.L.S. reports consulting fees from Cook Medical, Endologix Inc, Medtronic, Abbott Laboratories, and Silk Road Medical. EDAT- 2023/09/02 05:42 MHDA- 2023/11/21 06:43 CRDT- 2023/09/01 19:25 PHST- 2023/06/26 00:00 [received] PHST- 2023/08/18 00:00 [revised] PHST- 2023/08/23 00:00 [accepted] PHST- 2023/11/21 06:43 [medline] PHST- 2023/09/02 05:42 [pubmed] PHST- 2023/09/01 19:25 [entrez] AID - S0741-5214(23)01938-9 [pii] AID - 10.1016/j.jvs.2023.08.124 [doi] PST - ppublish SO - J Vasc Surg. 2023 Dec;78(6):1439-1448.e2. doi: 10.1016/j.jvs.2023.08.124. Epub 2023 Aug 30.