Detection of carotid artery stenosis using histological specimens: a comparison of CT angiography, magnetic resonance angiography, digital subtraction angiography and Doppler ultrasonography

Netuka, David; Belšán, T.; Broulíková, Karolina; Mandys, Václav; Charvát, František; Malík, Jozef; Coufalova, Lucie; Bradáč, Ondřej; Ostrý, Svatopluk; Beneš, Vladimı́r

doi:10.1007/s00701-016-2842-0

Cited by 26 publications

(19 citation statements)

References 24 publications

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“…However, when a large vessel has a moderate stenosis between 50–69% these non-invasive techniques have a lower sensitivity and specificity for the accurate detection of the degree of stenosis. 66–71 In recent years, there are no comparative studies of the two modalities with DSA in any large series of patients. A recent review that included previous and more contemporary studies of reported sensitivity and specificity for CTA of 81.7% and 85.6%, that may be lower than those reported for contrast-enhanced MRA.…”

Section: Resultsmentioning

confidence: 99%

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European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack

Fonseca

Merwick

Dennis

et al. 2021

European Stroke Journal

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The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4 or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4 or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.

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Section: Resultsmentioning

confidence: 99%

“…[66][67][68][69] However, when a large vessel has a moderate stenosis between 50-69% these non-invasive techniques have a lower sensitivity and specificity for the accurate detection of the degree of stenosis. [66][67][68][69][70][71] In recent years, there are no comparative studies of the two modalities with DSA in any large series of patients.…”

mentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack

Fonseca

Merwick

Dennis

et al. 2021

European Stroke Journal

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“…In contrast with some other studies which utilized CT angiography, we used cervical contrast MDCT and our diagnostic modality could be assumed as a potential limitation for estimating severity of CAS, but correlation of CT angiography with conventional angiography has shown to be strong, even better than Doppler ultrasonography. [27][28][29] Results of Doppler Ultrasound (DUS), magnetic resonance angiography (MRA), CT angiography (CTA) and digital subtraction angiography (DSA) with histopathology of atherosclerotic specimen have been Compared by Netuka et al, 30 and they found significant accuracy for each of these diagnostic modalities but the strongest correlation was observed for CTA. Although there are some papers in agreement with good correlation of CTA and DUS, 31,32 but there are some studies which shows underestimation of stenotic severity by CT comparing to DUS.…”

Section: Discussionmentioning

confidence: 99%

The Relation of Calcium Volume Score and Stenosis of Carotid Artery

Moradi

Mahdavi

Nogourani

2020

Journal of Stroke and Cerebrovascular Diseases

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“…Thus, the ultrasonographic data cannot compared with other imaging form like computed tomography angiography, magnetic resonance angiography or digital subtraction angiography. The Duplex ultrasonography may overestimate the degree of stenosis (34). However, any disagreement about the results was resolved by specialist team.…”

Section: Discussionmentioning

confidence: 99%

Extracranial Artery Stenosis Is Associated With Total MRI Burden of Cerebral Small Vessel Disease in Ischemic Stroke Patients of Suspected Small or Large Artery Origins

Liang

Ning-lin

et al. 2019

Front. Neurol.

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Background and Purpose: Extracranial artery stenosis (ECAS) is related to individual imaging markers of cerebral small vessel disease (cSVD). However, little has been reported on the association between ECAS and the total burden of cSVD as assessed by magnetic resonance imaging (MRI). The purpose of this study was to investigate the relationship between ECAS and cSVD burden in patients with ischemic stroke of suspected small or large artery origin. Methods: We reviewed consecutive patients with ischemic stroke of suspected small or large artery origin who underwent color Doppler ultrasonography and brain MRI. Bilateral extracranial cerebral arteries including common carotid artery, internal carotid artery (ICA), and proximal vertebral artery (VA, ostium, V2–3 segments) were assessed using color Doppler ultrasonography. ECAS severity was classified as no/mild stenosis, moderate stenosis, severe stenosis, or occlusion. The total cSVD score was assessed by awarding one point according to the load of each of these cSVD markers as determined using MRI; lacunar infarction, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces. The relationship between ECAS severity and cSVD burden according to MRI was examined. Results: Two hundred and twenty one patients were included in this study (mean age 61 ± 12 years, 75.6% male). Hypertension, current smoking, hyperlipidaemia, and diabetic mellitus were frequent among the patients (67.4, 45.7, 43.9, and 36.7%, respectively), while the other vascular risk factors including previous stroke or TIA and alcohol excess were less frequent (19.0 and 15.4%, respectively). Patients with higher total cSVD burden was significantly older and had severer ECAS. The frequency of hypertension was significantly higher in patients with higher total cSVD burden. This analysis indicated that that increasing ECAS severity (from no stenosis through to 100%) was independently associated with increasing total cSVD score after adjusting for other vascular risk factors (odds ratio 1.76, 95% CI [1.16–2.69]). Conclusions: In this study, high levels of ECAS from ultrasound evidence were associated with coexisting advanced cerebral cSVD in ischemic stroke patients of suspected small or large artery origin. Further studies are required to determine if and how extracranial arterial imaging helps reduce cSVD burden or improves cognitive function.

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Detection of carotid artery stenosis using histological specimens: a comparison of CT angiography, magnetic resonance angiography, digital subtraction angiography and Doppler ultrasonography

Cited by 26 publications

References 24 publications

European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack

European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack

The Relation of Calcium Volume Score and Stenosis of Carotid Artery

Extracranial Artery Stenosis Is Associated With Total MRI Burden of Cerebral Small Vessel Disease in Ischemic Stroke Patients of Suspected Small or Large Artery Origins

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