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Every year in the Netherlands, around 3,000 surgical procedures are performed to remove a narrowing or stenosis in the carotid artery, as they are one of the main causes of strokes. These life-saving procedures, which prevent disabling strokes, can cause post-surgery disruptions in blood flow patterns, risking the narrowing of the artery again. Research into this is now supported by a grant honored by the TURBO program.
Prof. Michel Reijnen, who specializes in Vascular Imaging and Innovation at the University of Twente, and Dr. Anne Saris, an expert in ultrasound-based flow imaging at Radboudumc, are comparing two of the most common surgical procedures for treating carotid artery stenosis. For the first time in this type of research, they are using Velocity Vector Imaging (VVI): a novel ultrasound imaging technique that captures highly detailed images of blood flow, tracking the speed and direction of groups of red blood cells as they move through the arteries. Their research aims to determine which surgical procedure is most effective for different patients, enabling healthcare providers to offer more personalized treatments in the long run.
The novel ultrasound flow imaging technique captures highly detailed images of blood flow. Arrows depict blood velocity and the direction in which it flows. The more yellow the arrow, the higher the velocity of the blood. The carotid artery of a patient, which is operated using the CEAP technique, is shown. At the bottom of the artery, a clear recirculating flow region is visible. (snelheid = velocity)
When treating carotid artery stenosis, surgeons typically use one of two methods: Carotid endarterectomy with patch angioplasty (CEAP) involves removing the inner layer of the artery and adding a patch — either tissue from the patient’s vein or synthetic material — to widen the vessel. The other option, the eversion technique (ET), avoids using a patch by removing the diseased inner layer of the vessel from the inside and closing the artery.
Both methods save lives and prevent disabling strokes, but each comes with a trade-off. CEAP has been linked to a higher risk of the narrowing returning over time, while with ET there may be less control over the farthest end of the treated artery.
'We will be the first to investigate post-surgical blood flow in operated carotid arteries using non-invasive ultrasound blood flow imaging. It is a unique opportunity to apply this innovative technology directly in the clinic.'
New technique – detailed images – greater precision
Reijnen and Saris will compare the blood flow of patients who have undergone CEAP and ET. The study’s novelty lies in using VVI: an ultrafast ultrasound technique that generates highly detailed images of blood flow, tracking the speed and direction of groups of red blood cells as they move through the arteries. Compared with conventional clinical systems, VVI captures up to 100 times more images per second. It visualizes critical parameters, such as velocity and direction, with exceptional precision and compares how these differ between the two surgical procedures.
Their findings could have enormous implications for future treatments. Identifying the most suitable surgical procedure for each patient could reduce the risk of recurrent narrowing, which in most cases occurs years after the operation, and possibly prevent subsequent strokes in the long run. Reijnen and Saris expect to identify differences in blood flow between CEAP and ET. In the future, this may lead to more insights into which blood flow profiles are predictive of recurrent arterial narrowing.
According to them, managing the large volume of collected data and determining which factors are critical to the disease process will be challenging. The blood flow images will provide countless measurements taken at different points in the cardiac cycle along the entire artery. Deciding which measurements are most reliable and relevant for predicting the progression of the condition will require considerable work.
The impact of this research extends beyond the treatment of carotid artery conditions. 'This research is a foundational step toward a large-scale comparative study in carotid pathology. The knowledge gained will also provide a basis for applying this technique to other vessels in the body.'
The team is collaborating with several research institutions and hospitals including Radboudumc, Medisch Spectrum Twente (MST), Rijnstate Hospital, and Elisabeth-TweeSteden Hospital (ETZ).
HealthTech Nexus and the TURBO program
HealthTech Nexus is the strategic collaboration between Radboudumc and the University of Twente at the intersection of healthcare and medical technology. Together they focus on the 'unmet need' of healthcare: urgent needs for which no good solutions yet exist.
This strategic platform brings together knowledge and expertise within a broad network of stakeholders inside and outside the healthcare sector. Cooperation is crucial to keeping tomorrow's care patient-oriented, sustainable, affordable, and accessible. Other parties are explicitly invited to join.
Reijnen and Saris’ team is one of four interdisciplinary teams from the Radboudumc and the University of Twente (TechMed Centre) that was honored by the TURBO program (Twente University RadBoudumc Opportunities).
For more information about HealthTech Nexus and the TURBO program visit: University of Twente (TechMed Centre) or Radboudumc.
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