Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial

Neale, Michael; Chambers, Jennifer L.; Kelly, Alison T.; Connard, Suzanne; Lawton, Margaret A.; Roche, James; Appleberg, Michael

doi:10.1016/0741-5214(94)90290-9

Cited by 173 publications

(73 citation statements)

References 18 publications

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“…This threshold is similar compared with the study of Heijenbrok-Kal et al [27] where an optimal threshold value of 220 cm/s was found, or compared with the study of Grant et al [28] where the proposed threshold was 230 cm/s. Yet, our cut-off value is lower compared to that proposed by Moneta et al (325 cm/s) [29] , by Neale et al (270 cm/s) [30] and Saba et al (283 cm/s) [31] . Given the heterogeneity of these findings, it seems sensible that clinicians involved in the diagnosis and management of carotid artery disease use with caution hemodynamic criteria.…”

Section: Discussioncontrasting

confidence: 48%

Doppler-Ultrasound and computed tomography correlation for quantification of carotid stenosis

Gioia

Mangiacapra

Sedati

et al. 2016

Med Imaging Interv Radiol

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Carotid disease is a major cause of cerebrovascular events. Risk is proportional to the extent and severity of atherosclerosis. Aim of this study was to assess the correlation between 64-multi-detector-row computed-tomography angiography (MDCTA) and Doppler ultrasound peak-systolic-velocity (DUS-PSV) in the quantification of stenosis. 116 consecutive patients were included; it was calculated the degree of carotid stenosis with the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method using MDCTA and DUS-PSV. MDCTA measurements of stenosis ranged from 35% to 95% (mean 67±16%). DUS-PSV ranged from 102 to 600 cm/s (mean 262±112 cm/s). A moderate correlation (r 2 = 0.427) was found between MDCTA-NASCET stenosis and PSV values. At ROC curve analysis, PSV could significantly discriminate between stenoses ≥70% and <70% at MDCTA-NASCET measurement, with area under the curve of 0.807 (p<0.0001). PSV value ≥230 cm/s was identified as optimal cutoff to predict stenosis ≥70% at MDCTA, with a sensitivity of 71%, specificity of 83%, negative predictive value of 67% and positive predictive value of 82%. We found a reasonable concordance between MDCTA and DUS-PSV in quantifying carotid stenosis. PSV value of 230 cm/s is a reliable threshold to predict a >70% stenosis of MDCTA.Keywords: Carotid; Doppler; MDCTA; Ultrasound To cite this article: Giuseppe Di Gioia, et al. Doppler-Ultrasound and computed tomography correlation for quantification of carotid stenosis.

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Section: Discussioncontrasting

confidence: 48%

Doppler-Ultrasound and computed tomography correlation for quantification of carotid stenosis

Gioia

Mangiacapra

Sedati

et al. 2016

Med Imaging Interv Radiol

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“…[7][8][9] This argument is based on the relative accuracy of Doppler ultrasound in previous studies. 5,6,[12][13][14][15] Dawson et al 5 prospectively studied 103 patients with 111 carotid stenoses with duplex scanning and conventional angiography. Carotid duplex studies were performed at vascular laboratories at 2 institutions.…”

Section: Discussionmentioning

confidence: 99%

Role of Conventional Angiography in Evaluation of Patients With Carotid Artery Stenosis Demonstrated by Doppler Ultrasound in General Practice

Qureshi

Suri

Ali

et al. 2001

Stroke

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Background and Purpose-Previous studies have suggested that patients with carotid stenosis who are candidates for endarterectomy can be effectively identified on the basis of carotid Doppler ultrasound alone. Before widespread acceptance of this policy, the accuracy of carotid Doppler ultrasound outside selected centers and clinical trials needs to be evaluated. We performed a 12-month prospective study to evaluate the accuracy of Doppler ultrasound in identifying patients for carotid intervention in general practice settings. Methods-Each patient referred to our endovascular service for diagnostic angiography to evaluate for carotid stenosis was interviewed and examined by a neurologist. Subjects consisted of symptomatic patients with Ն50% stenosis and asymptomatic patients with Ն60% stenosis by Doppler ultrasound. Information pertaining to demographic and cerebrovascular risk factors and the results of the carotid Doppler ultrasound were recorded. The severity of stenosis on angiograms was measured with North American Symptomatic Carotid Endarterectomy Trial criteria by a blinded observer. The results of both studies were compared to determine the relative accuracy of ultrasound results. Results-Of 130 patients (mean age, 69Ϯ8.8 years) who met Doppler ultrasound criteria, 22 (17%) and 8 patients (6%)were found to have 30% to 49% or Ͻ30% stenosis by angiography, respectively. The positive predictive value of carotid Doppler ultrasound for identifying appropriate symptomatic candidates for carotid intervention (angiographic stenosis Ն50%) was 80%, with a false-positive value of 20%. The positive predictive value of carotid Doppler ultrasound for identifying appropriate asymptomatic candidates for carotid intervention (angiographic stenosis Ն60%) was 59%, with a false-positive value of 41%. Carotid endarterectomy or angioplasty and stent placement were undertaken subsequently in 60 (46%) of the patients. In 94 patients who underwent cerebral angiography alone, no complications were observed. Conclusions-The present accuracy of carotid Doppler ultrasound in general practice does not justify its use as the sole basis of selecting appropriate patients for carotid intervention. Given the relatively low rate of associated morbidity with present day techniques, additional confirmatory studies such as angiography should be performed in every patient before a decision regarding intervention is made.

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“…So far, ultrasound Doppler examination has become well established for assessment of the lumen reduction caused by the carotid plaque [12], [26], [28], and the method has in some institutions supplanted arteriography even when carotid endarterectomy is planned. [16] However, during the last decade an increasing number of reports have indicated that Bmode ultrasound images of the carotid plaque reveal features (echogenicity and structure) related to the presence of brain infarcts on computed tomography images [17] and to the risk of developing new neurological symptoms [2], [6], [20], [22], [25], [32], [38].…”

mentioning

confidence: 99%

Quantitative analysis of ultrasound B-mode images of carotid atherosclerotic plaque: correlation with visual classification and histological examination

Wilhjelm

Grønholdt

Wiebe

et al. 1998

IEEE Trans. Med. Imaging

127

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Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial

Cited by 173 publications

References 18 publications

Doppler-Ultrasound and computed tomography correlation for quantification of carotid stenosis

Doppler-Ultrasound and computed tomography correlation for quantification of carotid stenosis

Role of Conventional Angiography in Evaluation of Patients With Carotid Artery Stenosis Demonstrated by Doppler Ultrasound in General Practice

Quantitative analysis of ultrasound B-mode images of carotid atherosclerotic plaque: correlation with visual classification and histological examination

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