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Updated: Jul 16, 2026
Monitoring the Wall Mechanics During Stent Deployment in a Vessel
Published on: May 8, 2012
Early Peak Systolic Velocity and Trend Variation Predict Stent Patency in Chronic Mesenteric Ischemia and Propose a
Ahmed A Sorour1, Abdullah Khan1, Enrico Prajiante Bertolino1
1Department of Vascular Surgery, Miller Family Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
Objective:
Stenting of the superior mesenteric artery (SMA) and celiac artery is the more prevalent treatment for symptomatic chronic mesenteric ischemia (CMI). The SVS recommends duplex ultrasound for post-stenting surveillance. This study aimed to determine whether early postoperative peak systolic velocity (PSV) and subsequent PSV progression predict primary patency (PP) loss after SMA stenting.
Methods:
Single-center retrospective analysis of 179 patients (240 vessels: 165 SMA, 75 celiac) treated between 2003 and 2020 with ≥2 years of follow-up. Early PSV was defined as duplex velocity within 3 months post-stenting. PSV progression was categorized as <100 cm/s or ≥100 cm/s absolute increase and <50% or ≥50% relative increase from baseline. Cox proportional hazards and time-dependent ROC analyses assessed associations between PSV and PP.
Results:
Higher early PSV was a strong independent predictor of PP loss. Each 10 cm/s increase in early SMA-PSV conferred a 5% higher risk of PP loss (HR 1.05; P < 0.001); similar trends were observed in celiac stents (HR 1.06, P 0.064). Progressive PSV increase over time was also predictive: a ≥100 cm/s rise tripled the risk of stent failure (HR 3.26; P 0.001), and a ≥50% rise yielded comparable risk (HR 3.58; P < 0.001). Progressive increase of SMA-PSV by 10 cm/s increased the risk of PP loss by 5% (HR: 1.05; P 0.008). ROC analysis at 24 months showed limited discriminative power for isolated velocity thresholds (AUC 0.66), underscoring the superior predictive value of PSV trends.
Conclusion:
Both elevated early PSV and progressive increases over time are strong, reproducible predictors of mesenteric stent failure. Every 10 cm/s rise in SMA PSV corresponds to a 4-5% increased risk of PP loss, while a ≥100 cm/s or ≥50% PSV rise triples failure risk. These findings establish PSV progression as a clinically meaningful marker of restenosis and propose a retrospective, hypothesis-generating surveillance framework.