Abstract
There are very limited data in the literature about the reliability of duplex ultrasound (DU) verified by angiography in patients with restenosis of the internal carotid artery (ICA) after carotid surgery compared with primary carotid artery stenosis patients. Our objective was to compare the reliability of DU verified by conventional angiography in the diagnosis of severe primary stenosis versus restenosis of ICA. One hundred thirty-four patients (238 arteries) were examined by both DU and angiography. Severe stenosis (>70%) was found in 47 primary stenotic arteries and in 70 restenotic arteries. Accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value were obtained for basic DU criteria after verification of ultrasound data by angiography. The best accuracy for detection of >70% stenosis by end diastolic velocity was found for the velocity of 70 cm/sec or more in both groups, but accuracy for the restenosis group was significantly higher (96.9% vs. 89.8%, p = 0.025). Additionally, specificity (p = 0.01) and PPV (p = 0.01) were significantly higher in the restenosis group. The best accuracy for detection of >70% stenosis by peak systolic velocity was found for the velocity of 220 cm/sec or more for restenoses and 200 cm/sec or more for primary stenoses. The accuracy of the ultrasound was significantly higher in the restenosis group (94.6% vs. 87%, p = 0.04), as were specificity (p = 0.01) and PPV (p = 0.02). The diagnosis of severe restenosis by DU is reliable and can be used for decision making regarding surgery or stenting without angiography. In patients with Doppler parameters pointing to borderline moderate/severe primary carotid stenosis and technically complicated cases, angiography in addition to sonography before surgery is recommended.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sanders EA, Hoeneveld H, Eikelboom BC, Ludwig JW, Vermeulen FE, Ackerstaff RG. Residual lesions and early recurrent stenosis after carotid endarterectomy. A serial follow-up study with duplex scanning and intravenous digital subtraction angiography. J Vasc Surg 1987;5:731–737
Schwarcz TH, Yates GN, Ghobrial M, Baker WH. Pathologic characteristics of recurrent carotid artery stenosis. J Vasc Surg 1987;5:280–288
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–453
College J, Wright R, Pugh N, Lane IF. Colour-coded duplex assessment alone before carotid endarterectomy. Br J Surg 1996;83:1234–1237
Ballotta E, Da Giau G, Abbruzzese E, et al. Carotid endarterectomy without angiography: can clinical evaluation and duplex ultrasonographic scanning alone replace traditional arteriography for carotid surgery workup? A prospective study. Surgery 1999;126:20–27
Chen JC, Salvian AJ, Taylor DC, Teal PA, Marotta TR, Hsiang YN. Can duplex ultrasonography select appropriate patients for carotid endarterectomy? Eur J Vasc Endovasc. Surg 1997;14:451–456
Plecha EJ, King TA, Pitluk HC, Rubin JR. Risk assessment in patients undergoing carotid endarterectomy. Cardiovasc Surg 1993;1:30–32
McKinsey JF, Desai TR, Bassiouny HS, et al. Mechanisms of neurologic deficits and mortality with carotid endarterectomy. Arch Surg 1996;131:526–531
Huber R, Muller BT, Seitz RJ, Siebler M, Modder U, Sandmann W. Carotid surgery in acute symptomatic patients. Eur J Vasc Endovasc Surg 2003;25:60–67
Johnston DC, Goldstein LB. Clinical carotid endarterectomy decision making: noninvasive vascular imaging versus angiography. Neurology 2001;56:1009–1015
Nederkoorn PJ, Mali WP, Eikelboom BC, et al. Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing. Stroke 2002;33:2003–2008
Back MR, Rogers GA, Wilson JS, Johnson BL, Shames ML, Bandyk DF. Magnetic resonance angiography minimizes need for arteriography after inadequate carotid duplex ultrasound scanning. J Vasc Surg 2003;38:422–430
Chen JC, Salvian AJ, Taylor DC, Teal PA, Marotta TR, Hsiang YN. Predictive ability of duplex ultrasonography for internal carotid artery stenosis of 70%-99%: a comparative study. Ann Vasc Surg 1998;12:244–247
Huston J 3rd, James EM, Brown RD Jr, et al. Redefined duplex ultrasonographic criteria for diagnosis of carotid artery stenosis. Mayo Clin Proc 2000;75:1133–1140
Koga M, Kimura K, Minematsu K, Yamaguchi T. Diagnosis of internal carotid artery stenosis greater than 70% with power Doppler duplex sonography. AJNR Am J Neuroradiol 2001;22:413–417
Staikov IN, Nedeltchev K, Arnold M, et al. Duplex sonographic criteria for measuring carotid stenoses. J Clin Ultrasound 2002;30:275–281
Carpenter JP, Lexa FJ, Davis JT. Determination of duplex Doppler ultrasound criteria appropriate to the North American Symptomatic Carotid Endarterectomy Trial. Stroke 1996;27:695–699
Ray SA, Lockhart SJ, Dourado R, Irvine AT, Burnand KG. Effect of contralateral disease on duplex measurements of internal carotid artery stenosis. Br J Surg 2000;87:1057–1062
Moneta GL, Edwards JM, Chitwood RW, et al. Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning. J Vasc Surg 1993;17:152–159
Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis-Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003;229:340–346
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Telman, G., Kouperberg, E., Sprecher, E. et al. Duplex Ultrasound Verified by Angiography in Patients with Severe Primary and Restenosis of Internal Carotid Artery. Ann Vasc Surg 20, 478–481 (2006). https://doi.org/10.1007/s10016-006-9049-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10016-006-9049-4