{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:50:29Z","timestamp":1791597029246,"version":"4.3.4"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The mechanism of carotid endarterectomy (CEA) restenosis remains unclear. Our research aimed to investigate the relationship between the carotid plaque grayscale median (GSM) value and restenosis after CEA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Between January 2010 and January 2018, 1280 consecutive patients underwent CEA at our institution; 32 patients were diagnosed with restenosis by ultrasound at 1 year after CEA. The correlations between plaque GSM, plaque echogenicity, clinical manifestations, shunting, and restenosis were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In total, 829 patients were ultimately enrolled; 32 (4%) presented diagnoses of restenosis (mean age 67.3 \u00b1 8.0 years, 81.2% men). The GSM value was lower in the restenosis group (68.1 \u00b1 19.9 vs 59.9 \u00b1 14.7, p = 0.02). After multiple logistic regression analysis, the GSM value was found to be an independent risk factor for restenosis (OR 0.976, 95% CI 0.957\u20130.995). Shunting was another significant independent risk factor for restenosis (OR 2.39, 95% CI 1.07\u20135.34). The GSM cutoff value for predicting restenosis was 75 (sensitivity 0.38, specificity 0.84, area under the curve 0.62). We separated the patients into 2 groups by GSM (GSM \u2264 75 and GSM &gt; 75 subgroups). Comparison of the 2 groups indicated that symptomatic manifestation was related to restenosis in the subgroup with GSM \u2264 75, indicating predominantly echolucent plaques, but not in the subgroup with GSM &gt; 75, indicating predominantly echogenic plaques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Predominantly echolucent carotid plaques, as measured by GSM, had a higher restenosis risk at 1 year than echogenic plaques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2020.2.jns193397","type":"journal-article","created":{"date-parts":[[2020,4,17]],"date-time":"2020-04-17T03:36:35Z","timestamp":1587094595000},"page":"1203-1209","source":"Crossref","is-referenced-by-count":12,"title":["Echolucent carotid plaque is associated with restenosis after carotid endarterectomy"],"prefix":"10.3171","volume":"134","author":[{"given":"Qing","family":"Li","sequence":"first","affiliation":[{"name":"Departments of Vascular Ultrasound and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beibei","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Vascular Ultrasound and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhao","sequence":"additional","affiliation":[{"name":"Departments of Vascular Ultrasound and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumei","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Vascular Ultrasound and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingjie","family":"Gao","sequence":"additional","affiliation":[{"name":"Departments of Vascular Ultrasound and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingyun","family":"Jia","sequence":"additional","affiliation":[{"name":"Departments of Vascular Ultrasound and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqun","family":"Jiao","sequence":"additional","affiliation":[{"name":"Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Hua","sequence":"additional","affiliation":[{"name":"Departments of Vascular Ultrasound and"},{"name":"Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"20","key":"b1","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1056\/NEJM199811123392002","article-title":"Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators","volume":"339","author":"Barnett\n \nHJ","year":"1998","unstructured":"Barnett\n \nHJ\n\n, \n\nTaylor\n \nDW\n\n, \n\nEliasziw\n \nM\n\n, \n\n\n \nBenefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators\n. \nN Engl J Med\n. \n1998\n;\n339\n(\n20\n):\n1415\n\u2013\n1425\n.\n10.1056\/NEJM199811123392002"},{"issue":"4","key":"b2","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1161\/STROKEAHA.110.589309","article-title":"Restenosis is more frequent after carotid stenting than after endarterectomy: the EVA-3S study","volume":"42","author":"Arquizan\n \nC","year":"2011","unstructured":"Arquizan\n \nC\n\n, \n\nTrinquart\n \nL\n\n, \n\nTouboul\n \nPJ\n\n, \n\n\n \nRestenosis is more frequent after carotid stenting than after endarterectomy: the EVA-3S study\n. \nStroke\n. \n2011\n;\n42\n(\n4\n):\n1015\n\u2013\n1020\n.\n10.1161\/STROKEAHA.110.58930921311065"},{"issue":"10","key":"b3","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1016\/S1474-4422(09)70227-3","article-title":"Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial","volume":"8","author":"Bonati\n \nLH","year":"2009","unstructured":"Bonati\n \nLH\n\n, \n\nEderle\n \nJ\n\n, \n\nMcCabe\n \nDJ\n\n, \n\n\n \nLong-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial\n. \nLancet Neurol\n. \n2009\n;\n8\n(\n10\n):\n908\n\u2013\n917\n.\n10.1016\/S1474-4422(09)70227-3"},{"issue":"1","key":"b4","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1056\/NEJMoa0912321","article-title":"Stenting versus endarterectomy for treatment of carotid-artery stenosis","volume":"363","author":"Brott\n \nTG","year":"2010","unstructured":"Brott\n \nTG\n\n, \n\nHobson\n \nRW\n \nII\n\n, \n\nHoward\n \nG\n\n, \n\n\n \nStenting versus endarterectomy for treatment of carotid-artery stenosis\n. \nN Engl J Med\n. \n2010\n;\n363\n(\n1\n):\n11\n\u2013\n23\n.\n10.1056\/NEJMoa091232120505173"},{"issue":"10","key":"b5","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/S1474-4422(08)70196-0","article-title":"Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial","volume":"7","author":"Eckstein\n \nHH","year":"2008","unstructured":"Eckstein\n \nHH\n\n, \n\nRingleb\n \nP\n\n, \n\nAllenberg\n \nJR\n\n, \n\n\n \nResults of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial\n. \nLancet Neurol\n. \n2008\n;\n7\n(\n10\n):\n893\n\u2013\n902\n.\n1877474610.1016\/S1474-4422(08)70196-0"},{"issue":"15","key":"b6","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1056\/NEJMoa0708028","article-title":"Long-term results of carotid stenting versus endarterectomy in high-risk patients","volume":"358","author":"Gurm\n \nHS","year":"2008","unstructured":"Gurm\n \nHS\n\n, \n\nYadav\n \nJS\n\n, \n\nFayad\n \nP\n\n, \n\n\n \nLong-term results of carotid stenting versus endarterectomy in high-risk patients\n. \nN Engl J Med\n. \n2008\n;\n358\n(\n15\n):\n1572\n\u2013\n1579\n.\n1840376510.1056\/NEJMoa0708028"},{"issue":"9","key":"b7","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1016\/S1474-4422(12)70159-X","article-title":"Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial","volume":"11","author":"Lal\n \nBK","year":"2012","unstructured":"Lal\n \nBK\n\n, \n\nBeach\n \nKW\n\n, \n\nRoubin\n \nGS\n\n, \n\n\n \nRestenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial\n. \nLancet Neurol\n. \n2012\n;\n11\n(\n9\n):\n755\n\u2013\n763\n.\n2285785010.1016\/S1474-4422(12)70159-X"},{"issue":"5","key":"b8","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1001\/jama.299.5.547","article-title":"Atherosclerotic plaque composition and occurrence of restenosis after carotid endarterectomy","volume":"299","author":"Hellings\n \nWE","year":"2008","unstructured":"Hellings\n \nWE\n\n, \n\nMoll\n \nFL\n\n, \n\nDe Vries\n \nJP\n\n, \n\n\n \nAtherosclerotic plaque composition and occurrence of restenosis after carotid endarterectomy\n. \nJAMA\n. \n2008\n;\n299\n(\n5\n):\n547\n\u2013\n554\n.\n1825288510.1001\/jama.299.5.547"},{"issue":"11","key":"b9","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3040","DOI":"10.1161\/STROKEAHA.107.490581","article-title":"Analysis of calcium in carotid plaques with Agatston scores for appropriate selection of surgical intervention","volume":"38","author":"Katano\n \nH","year":"2007","unstructured":"Katano\n \nH\n\n, \n\nYamada\n \nK\n\n\n. \nAnalysis of calcium in carotid plaques with Agatston scores for appropriate selection of surgical intervention\n. \nStroke\n. \n2007\n;\n38\n(\n11\n):\n3040\n\u2013\n3044\n.\n10.1161\/STROKEAHA.107.49058117901382"},{"issue":"6","key":"b10","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1093\/neuros\/nyw119","article-title":"Analysis of recurrent stenosis after carotid endarterectomy featuring primary plaque calcification","volume":"80","author":"Katano\n \nH","year":"2017","unstructured":"Katano\n \nH\n\n, \n\nMase\n \nM\n\n, \n\nNishikawa\n \nY\n\n, \n\n\n \nAnalysis of recurrent stenosis after carotid endarterectomy featuring primary plaque calcification\n. \nNeurosurgery\n. \n2017\n;\n80\n(\n6\n):\n863\n\u2013\n870\n.\n2836852710.1093\/neuros\/nyw119"},{"issue":"2","key":"b11","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1148\/radiol.2292030516","article-title":"Carotid artery stenosis: gray-scale and Doppler US diagnosis\u2014Society of Radiologists in Ultrasound Consensus Conference","volume":"229","author":"Grant\n \nEG","year":"2003","unstructured":"Grant\n \nEG\n\n, \n\nBenson\n \nCB\n\n, \n\nMoneta\n \nGL\n\n, \n\n\n \nCarotid artery stenosis: gray-scale and Doppler US diagnosis\u2014Society of Radiologists in Ultrasound Consensus Conference\n. \nRadiology\n. \n2003\n;\n229\n(\n2\n):\n340\n\u2013\n346\n.\n10.1148\/radiol.229203051614500855"},{"issue":"10","key":"b12","series-title":"Br J Surg","doi-asserted-by":"publisher","first-page":"1274","DOI":"10.1002\/bjs.1800801016","article-title":"Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography","volume":"80","author":"Geroulakos\n \nG","year":"1993","unstructured":"Geroulakos\n \nG\n\n, \n\nRamaswami\n \nG\n\n, \n\nNicolaides\n \nA\n\n, \n\n\n \nCharacterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography\n. \nBr J Surg\n. \n1993\n;\n80\n(\n10\n):\n1274\n\u2013\n1277\n.\n10.1002\/bjs.18008010168242296"},{"issue":"2","key":"b13","series-title":"Eur J Vasc Endovasc Surg","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.ejvs.2014.05.015","article-title":"Identification of patients with a histologically unstable carotid plaque using ultrasonic plaque image analysis","volume":"48","author":"Salem\n \nMK","year":"2014","unstructured":"Salem\n \nMK\n\n, \n\nBown\n \nMJ\n\n, \n\nSayers\n \nRD\n\n, \n\n\n \nIdentification of patients with a histologically unstable carotid plaque using ultrasonic plaque image analysis\n. \nEur J Vasc Endovasc Surg\n. \n2014\n;\n48\n(\n2\n):\n118\n\u2013\n125\n.\n10.1016\/j.ejvs.2014.05.01524947079"},{"issue":"6","key":"b14","series-title":"Circulation","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1161\/01.CIR.0000138103.91187.E3","article-title":"Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study","volume":"110","author":"Biasi\n \nGM","year":"2004","unstructured":"Biasi\n \nGM\n\n, \n\nFroio\n \nA\n\n, \n\nDiethrich\n \nEB\n\n, \n\n\n \nCarotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study\n. \nCirculation\n. \n2004\n;\n110\n(\n6\n):\n756\n\u2013\n762\n.\n1527732010.1161\/01.CIR.0000138103.91187.E3"},{"key":"b15","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e686","DOI":"10.1016\/j.wneu.2017.12.151","article-title":"Comparison of monitoring of cerebral blood flow by c-FLOW and transcranial doppler in carotid endarterectomy","volume":"111","author":"Wang\n \nX","year":"2018","unstructured":"Wang\n \nX\n\n, \n\nYang\n \nB\n\n, \n\nMa\n \nY\n\n, \n\n\n \nComparison of monitoring of cerebral blood flow by c-FLOW and transcranial doppler in carotid endarterectomy\n. \nWorld Neurosurg\n. \n2018\n;\n111\n:\ne686\n\u2013\ne692\n.\n10.1016\/j.wneu.2017.12.15129305914"},{"issue":"3","key":"b16","series-title":"Acta Neurol Scand","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1034\/j.1600-0404.2000.101003188.x","article-title":"Preoperative B-mode ultrasound plaque appearance compared with carotid endarterectomy specimen histology","volume":"101","author":"Schulte-Altedorneburg\n \nG","year":"2000","unstructured":"Schulte-Altedorneburg\n \nG\n\n, \n\nDroste\n \nDW\n\n, \n\nHaas\n \nN\n\n, \n\n\n \nPreoperative B-mode ultrasound plaque appearance compared with carotid endarterectomy specimen histology\n. \nActa Neurol Scand\n. \n2000\n;\n101\n(\n3\n):\n188\n\u2013\n194\n.\n10.1034\/j.1600-0404.2000.101003188.x10705942"},{"issue":"6","key":"b17","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"1772","DOI":"10.1016\/j.jvs.2018.01.068","article-title":"Carotid artery plaque echomorphology and its association with histopathologic characteristics","volume":"68","author":"Spanos\n \nK","year":"2018","unstructured":"Spanos\n \nK\n\n, \n\nTzorbatzoglou\n \nI\n\n, \n\nLazari\n \nP\n\n, \n\n\n \nCarotid artery plaque echomorphology and its association with histopathologic characteristics\n. \nJ Vasc Surg\n. \n2018\n;\n68\n(\n6\n):\n1772\n\u2013\n1780\n.\n10.1016\/j.jvs.2018.01.06829803682"},{"issue":"3","key":"b18","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1161\/STROKEAHA.107.496703","article-title":"Histological characterization of restenotic carotid plaques in relation to recurrence interval and clinical presentation: a cohort study","volume":"39","author":"Hellings\n \nWE","year":"2008","unstructured":"Hellings\n \nWE\n\n, \n\nMoll\n \nFL\n\n, \n\nde Vries\n \nJP\n\n, \n\n\n \nHistological characterization of restenotic carotid plaques in relation to recurrence interval and clinical presentation: a cohort study\n. \nStroke\n. \n2008\n;\n39\n(\n3\n):\n1029\n\u2013\n1032\n.\n1825883510.1161\/STROKEAHA.107.496703"},{"issue":"1","key":"b19","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s00701-013-1911-x","article-title":"Spontaneous regression of restenosis after CEA: significance of preoperative plaque characteristics under duplex ultrasound; clinical investigation","volume":"156","author":"Takami\n \nH","year":"2014","unstructured":"Takami\n \nH\n\n, \n\nMizutani\n \nT\n\n, \n\nOta\n \nT\n\n, \n\nYuyama\n \nR\n\n\n. \nSpontaneous regression of restenosis after CEA: significance of preoperative plaque characteristics under duplex ultrasound; clinical investigation\n. \nActa Neurochir (Wien)\n. \n2014\n;\n156\n(\n1\n):\n63\n\u2013\n67\n.\n10.1007\/s00701-013-1911-x"},{"issue":"1","key":"b20","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.jvs.2007.02.055","article-title":"Restenosis after eversion vs patch closure carotid endarterectomy","volume":"46","author":"Crawford\n \nRS","year":"2007","unstructured":"Crawford\n \nRS\n\n, \n\nChung\n \nTK\n\n, \n\nHodgman\n \nT\n\n, \n\n\n \nRestenosis after eversion vs patch closure carotid endarterectomy\n. \nJ Vasc Surg\n. \n2007\n;\n46\n(\n1\n):\n41\n\u2013\n48\n.\n1760612010.1016\/j.jvs.2007.02.055"},{"issue":"2","key":"b21","series-title":"Atherosclerosis","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1016\/j.atherosclerosis.2014.10.093","article-title":"A lipid-poor plaque and asymptomatic status in women are associated with higher peak systolic velocity on duplex ultrasound after carotid endarterectomy","volume":"237","author":"Vrijenhoek\n \nJE","year":"2014","unstructured":"Vrijenhoek\n \nJE\n\n, \n\nde Borst\n \nGJ\n\n, \n\nden Ruijter\n \nHM\n\n, \n\n\n \nA lipid-poor plaque and asymptomatic status in women are associated with higher peak systolic velocity on duplex ultrasound after carotid endarterectomy\n. \nAtherosclerosis\n. \n2014\n;\n237\n(\n2\n):\n677\n\u2013\n683\n.\n2546310510.1016\/j.atherosclerosis.2014.10.093"},{"issue":"2","key":"b22","series-title":"Interact Cardiovasc Thorac Surg","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1510\/icvts.2009.231878","article-title":"Postoperative internal carotid artery restenosis after local anesthesia: presence of risk factors versus intraoperative shunt","volume":"11","author":"Hudorovic\n \nN","year":"2010","unstructured":"Hudorovic\n \nN\n\n, \n\nLovricevic\n \nI\n\n, \n\nHajnic\n \nH\n\n, \n\nAhel\n \nZ\n\n\n. \nPostoperative internal carotid artery restenosis after local anesthesia: presence of risk factors versus intraoperative shunt\n. \nInteract Cardiovasc Thorac Surg\n. \n2010\n;\n11\n(\n2\n):\n182\n\u2013\n184\n.\n10.1510\/icvts.2009.23187820439301"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/134\/4\/article-p1203.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/134\/4\/article-p1203.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/134\/4\/article-p1203.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:12:51Z","timestamp":1791594771000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/134\/4\/article-p1203.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":22,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2020.2.jns193397","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}