Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#4 CAN DUPLEX CRITERIA BE USED TO RELIABLY PREDICT ARTERIOGRAPHIC STENOSIS PRIOR TO CAROTID ENDARTERECTOMY?
Edward D. Kreske, MD, Seth W. Wolk, MD, Richard M. Lampman, PhD, James E. Knake, MD, Charles J. Shanley, MD, Leslie A. Oang, MS, Errol E. Erlandson, MD, and Walter M. Whitehouse, Jr., MD St. Joseph Mercy Hospital Ann Arbor, MI
Carotid duplex scanning is being used more frequently as the sole preoperative diagnostic imaging modality for patients considered candidates for carotid endarterectomy. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has clearly demonstrated the benefit of surgical treatment for carotid stenoses exceeding 70%. The purpose of this study was to determine duplex criteria that accurately predict carotid stenoses exceeding 50% and 70%, as defined by NASCET arteriographic criteria.
One hundred forty-one patients (264 carotid arteries) considered surgical candidates were prospectively studied over a two year period using both duplex scanning (Acuson 128XP10, 7-MHz Doppler Transducer) and digital subtraction cerebral arteriography. Carotid artery stenosis was determined by a single, blinded radiologist using NASCET criteria. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured in the internal carotid (ICA) and common carotid (CCA) arteries using duplex scanning. ICA/CCA velocity ratios were calculated for PSV and EDV, respectively. Sensitivity 9SENS), specificity (SPEC), positive (PPV), and negative (NPV) predictive values and accuracy (ACCUR) were calculated.
Determination of Arteriographic Carotid Stenosis Using PSVICA/PSVCCA
Stenosis Criteria SENS SPEC PPV NPV ACCUR
>50% PSVICA/PSVCCA >1.6 88% 81% 86% 84% 85%
>70% PSVICA/PSVCCA >3.0 89% 91% 86% 93% 90%
PSVICA/PSVCCA provided the highest sensitivity and specificity in our laboratory. Arteriographic stenosis exceeding 50% and 70% were reliably predicted using these duplex criteria. We conclude that duplex criteria can be used to predict carotid stenoses exceeding 50% and 70% as defined by NASCET arteriographic criteria. These criteria should be independently validated by other vascular laboratories.
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Last updated January 10, 1999