Abstract
Various noninvasive tests for the evaluation of cerebrovascular insufficiency have been described in previous chapters. Most forms of noninvasive testing pose less stress and less expense to the patient than angiography. While early forms of noninvasive testing depended on the presence of severe disease, the current techniques, especially carotid artery imaging, demonstrate the opposite characteristic. Carotid imaging is able to detect minimal disease that is not hemodynamically significant; in fact, overestimation of the degree of stenosis in these cases has been a consistent problem. Nevertheless, any test intended for screening must have a high degree of sensitivity to be used appropriately in the initial assessment of disease. Noninvasive assessment, therefore, combines low risk, low cost, and high sensitivity.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Cartier R, Cartier P, Fontaine A. Carotid endarterectomy without angiography: The reliability of Doppler ultrasonography and duplex scanning in preoperative assessment. Can J Surg 1993;36:411–421.
Polak JF. Noninvasive carotid evaluation: Carpe diem. Radiology 1993;186:329–331.
Moore WS, Ziomek S, Quinones-Baldrich WJ, et al. Can clinical evaluation and noninvasive testing substitute for arteriography in the evaluation of carotid artery disease? Ann Surg 1988;208:91–94.
Norris JW, Halliday A. Is ultrasound sufficient for vascular imaging prior to carotid endarterectomy? Stroke 2004;35:370–371.
Moore WS. For severe carotid stenosis found on ultrasound, further arterial evaluation is unnecessary. Stroke 2003;34:1816–1817.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273:1421–1428.
Dawson DL, Zierler RE, Strandness DE Jr, et al. The role of duplex scanning and arteriography before carotid endarterectomy: A prospective study. J Vasc Surg 1993;18:673–683.
Horn M, Michelini M, Greisler HP, et al. Carotid endarterectomy without arteriography: The preeminent role of the vascular laboratory. Ann Vasc Surg 1994;8:221–224.
Chervu A, Moore WS. Carotid endarterectomy without arteriography. Ann Vasc Surg 1994;8:296–302.
Mattos MA, Hodgson KJ, Faught WE, et al. Carotid endarterectomy without angiography: Is color-flow duplex scanning sufficient? Surgery 1994;116:776–783.
Walsh J, Markowitz I, Kerstein MD. Carotid endarterectomy for amaurosis fugax without angiography. Am J Surg 1986;152:172–174.
Marshall WG, Jr.,Kouchoukos NT, Murphy SF, et al. Carotid endarterectomy based on duplex scanning without preoperative arteriography. Circulation 1988;78(Suppl I):I-1–I-5.
Nederkoorn PJ, Mali WPTM, Eikelboom BC, Elgersma OEH, Buskens E, Hunink MGM, Kappell LJ, Buijs PC, Wust AFJ, Lugt van der Lugt A, van der Graaf Y. Preoperative diagnosis of carotid artery stenosis: Accuracy of noninvasive testing. Stroke 2002;33:2003–2008.
Nederkoorn PJ, van der Graaf Y, Hunink Y. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis. Stroke 2003;34:1324–1332.
Westwood ME, Kelly S, Berry E, Bamford JM, Gough MJ, Airey CM, Meaney JFM, Davies LM, Cullingworth J, Smith MA. Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: A systematic review. BMJ 2002;324:1–5.
Jackson MR, Chang AS, Robles HA, et al. Determination of 60% or greater carotid stenosis: A prospective comparison of magnetic resonance angiography and duplex ultrasound with conventional angiography. Ann Vasc Surg 1998;12:236–243.
Willinek WA, von Falkenhausen M, Born M, Gieseke J, Holler T, Klockgether T, Textor HJ, Schild HH, Urbach H. Noninvasive detection of steno-occlusive disease of the supra-aortic arteries with three-dimensional contrastenhanced magnetic resonance angiography. A prospective, intra-individual comparative analysis with digital subtraction angiography. Stroke 2005;36:38–43.
Al-Kwifi O, Kim JK, Stainsby J, Huang Y, Sussman MS, Farb RI, Wright GA. Pulsatile motion effects on 3-D magnetic resonance angiography: Implications for evaluating carotid artery stenoses. Magn Reson Med 2004;52:605–611.
van Bemmel CM, Elgersma OE, Vonken EJ, Fiorelli M, van Leeuwen MS, Niessen WJ. Evaluation of semiautomated internal carotid artery stenosis quantification from 3-dimensional contrast-enhanced magnetic resonance angiograms. Invest Radiol 2004;39:418–426.
Kim DY, Park JW. Computerized quantification of carotid artery stenosis using MRA axial images. Magn Reson Imaging 2004;22:353–359.
U-King-Im JM, Trivedi R, Cross J, Higgins N, Graves M, Kirkpatrick P, Antoun N, Gillard JH. Conventional digital subtraction x-ray angiography versus magnetic resonance angiography in the evaluation of carotid disease: Patient satisfaction and preferences. Clin Radiol 2004;59:358–363.
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.
Anderson GB, Ashforth R, Steinke DE, Ferdinancy R, Findlay JM. CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke 2000;31:2168–2174.
Koelemay MJ, Nederkoorn PJ, Reitsma JB, Majoie CB. Systematic review of computed tomographic angiography for assessment of carotid artery disease. Stroke 2004;35:2306–2312.
Fell G, Breslau P, Know RA, et al. Importance of noninvasive ultrasonic Doppler testing in the evaluation of patients with asymptomatic carotid bruits. Am Heart J 1981;102:221–226.
North American Symptomatic Carotid Endarterectomy Trial (NASCET) Investigators. Clinical alert: Benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke, Stroke and Trauma Division. Stroke 1991;22:816–817.
AbuRahma AF, Robinson PA, Boland JP, et al. Complications of arteriography in a recent series of 707 cases: Factors affecting outcome. Ann Vasc Surg 1993;7:122–129.
AbuRahma AF, Robinson PA, Stickler DL, et al. Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials. Ann Vasc Surg 1998;12:349–358.
Sigel B, Coelho JC, Flanigan DP, et al. Detection of vascular defects during operation by imaging ultrasound. Ann Surg 1982;196:473–480.
Blaisdell FW, Lin R, Hall AD. Technical result of carotid endarterectomy—arteriographic assessment. Am J Surg 1967;114:239–246.
Bandyk DF, Govostis DM. Intraoperative color flow imaging of “difficult” arterial reconstructions. Video J Color Flow Imaging 1991;1:13–20.
Hallett JW Jr, Berger MW, Lewis BD. Intraoperative colorflow duplex ultrasonography following carotid endarterectomy. Neurosurg Clin North Am 1996;7:733–740.
Baker WH,Koustas G, Burke K, et al. Intraoperative duplex scanning and late carotid artery stenosis. J Vasc Surg 1994;19:829–833.
Kinney EV, Seabrook GR, Kinney LY, et al. The importance of intraoperative detection of residual flow abnormalities after carotid artery endarterectomy. J Vasc Surg 1993;17:912–922.
Coe DA, Towne JB, Seabrook GR, et al. Duplex morphologic features of the reconstructed carotid artery: Changes occurring more than five year after endarterectomy. J Vasc Surg 1997;25:850–857.
Cato R, Bandyk D, Karp D, et al. Duplex scanning after carotid reconstruction: A comparison of intraoperative and postoperative results. J Vasc Tech 1991;15:61–65.
Lane RJ, Ackroyd N, Appleberg M, et al. The application of operative ultrasound immediately following carotid endarterectomy. World J Surg 1987;11:593–597.
Sawchuk AP, Flanigan DP, Machi J, et al. The fate of unrepaired minor technical defects detected by intraoperative ultrasound during carotid endarterectomy. J Vasc Surg 1989;9:671–676.
Ascher E, Markevich N, Kallakuri S, Schutzer RW, Hingorani AP. Intraoperative carotid artery duplex scanning in a modern series of 650 consecutive primary endarterectomy procedures. J Vasc Surg 2004;39:416–420.
Halsey JH Jr. Risks and benefits of shunting in carotid endarterectomy. Stroke 1992;23:1583–1587.
Ackerstaff RGA, Moons KGM, van de Vlasakker CJW, Moll FL, Vermeulen FEE, Algra A, Spencer MP. Association of intraoperative transcranial Doppler monitoring variables with stroke from carotid endarterectomy. Stroke 2000;31:1817–1823.
Thomas M, Otis S, Rush M, et al. Recurrent carotid artery stenosis following endarterectomy. Ann Surg 1984;200:74–79.
Mattos MA, Shamma AR, Rossi N, et al. Is duplex followup cost-effective in the first year after carotid endarterectomy? Am J Surg 1988;156:91–95.
Cook JM, Thompson BW, Barnes RW. Is routine duplex examination after carotid endarterectomy justified? J Vasc Surg 1990;12:334–340.
Mackey WC, Belkin M, Sindhi R, et al. Routine postendarterectomy duplex surveillance: Does it prevent late stroke? J Vasc Surg 1992;16:934–940.
Mattos MA, van Bemmelen PS, Barkmeier LD, et al. Routine surveillance after carotid endarterectomy: Does it affect clinical management? J Vasc Surg 1993;17:819–831.
Ouriel K, Green RM. Appropriate frequency of carotid duplex testing following carotid endarterectomy. Am J Surg 1995;170:144–147.
Ricotta JJ, DeWeese JA. Is route carotid ultrasound surveillance after carotid endarterectomy worthwhile? Am J Surg 1996;172:140–143.
Golledge J, Cuming R, Ellis M, et al. Clinical follow-up rather than duplex surveillance after carotid endarterectomy. J Vasc Surg 1997;25:55–63.
AbuRahma AF, Robinson PA, Saiedy S, et al. Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: Long-term follow-up. J Vasc Surg 1998;27:222–234.
Patel ST, Kuntz KM, Kent KG. Is routine duplex ultrasound surveillance after carotid endarterectomy cost-effective? Surgery 1998;124:343–353.
Roth SM, Back MR, Bandyk DF, et al. A rational algorithm for duplex scan surveillance after carotid endarterectomy. J Vasc Surg 1999;30:453–460.
Ricco JB, Camiade C, Roumy J, Neau JP. Modalities of surveillance after carotid endarterectomy: Impact of surgical technique. Ann Vasc Surg 2003;17:386–392.
Lovelace TD, Moneta GL, Abou-Zamzam AH, Edwards JM, Yeager RA, Landry GJ, Taylor LM, Porter JM. Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%. J Vasc Surg 2001;33:56–61.
AbuRahma AF, Snodgrass KR, Robinson PA, et al. Safety and durability of redo carotid endarterectomy for recurrent carotid artery stenosis. Am J Surg 1994;168:175–178.
Kupinski AM, Khan AM, Stanton JE, Relyea W, Ford T, Mackey V, Khurana Y, Darling RC, Shah DM. Duplex ultrasound follow-up of carotid stents. J Vasc Ultrasound 2004;28:71–75.
Robbin ML, Lockhart ME,Weber TM, et al. Carotid artery stent: Early and intermediate follow-up with Doppler ultrasound. Radiology 1997;205:749–756.
Roederer GO, Langlois YE, Jager KA, et al. The natural history of carotid artery disease in asymptomatic patients with cervical bruits. Stroke 1984;15:605–613.
AbuRahma AF, Hannay RS, Khan JH, et al. Prospective randomized study of carotid endarterectomy with polytetrafluoroethylene versus collagen impregnated Dacron (Hemashield) patching: Perioperative (30-day) results. J Vasc Surg 2002;35:125–130.
Dawson DL, Zierler RE, Kohler TR. Role of arteriography in the preoperative evaluation of carotid artery disease. Am J Surg 1991;161:619–624.
Kuntz KM, Skillman JJ, Whittemore AD, et al. Carotid endarterectomy in asymptomatic patients: Is contrast angiography necessary? A morbidity analysis. J Vasc Surg 1995;22:706–716.
Kent KC, Kuntz KM, Patel MR. Perioperative imaging strategies for carotid endarterectomy: An analysis of morbidity and cost-effectiveness in symptomatic patients. JAMA 1995;274:888–893.
Campron H, Cartier R, Fontaine AR. Prophylactic carotid endarterectomy without arteriography in patients without hemispheric symptoms: Surgical morbidity and mortality and long-term follow-up. Ann Vasc Surg 1998;12:10–16.
Roederer GO, Langlois YE, Chan ARW, et al. Is siphon disease important in predicting outcome of carotid endarterectomy? Arch Surg 1983;118:1177–1181.
Mattos MA, van Bemmelen PS, Hodgson KJ, et al. The influence of carotid siphon stenosis on short and long-term outcome after carotid endarterectomy. J Vasc Surg 1993;17:902–911.
Lord RSA. Relevance of siphon stenosis and intracranial aneurysm to results of carotid endarterectomy. In: Ernst CB, Stanley JC (eds). Current Therapy in Vascular Surgery, 2nd ed., pp. 94–101. Philadelphia, PA: BC Decker, 1991.
Strandness DE Jr. Extracranial arterial disease, In: Strandness DR Jr (ed). Duplex Scanning in Vascular Disorders, 2nd ed., pp. 113–158. New York: Raven Press, 1993.
Pilcher DB, Ricci MA. Vascular ultrasound. Surg Clin North Am 1998;78:273–293.
AbuRahma AF, White JF III, Boland JP. Carotid endarterectomy for symptomatic carotid artery disease demonstrated by duplex ultrasound with minimal arteriographic findings. Ann Vasc Surg 1996;10:385–389.
AbuRahma AF, Kyer PD III, Robinson PA, et al. The correlation of ultrasonic carotid plaque morphology and carotid plaque hemorrhage: Clinical implications. Surgery 1998;124:721–728.
AbuRahma AF, Thiele SP, Wulu JT. Prospective controlled study of the natural history of asymptomatic 60% to 69% carotid stenosis according to ultrasonic plaque morphology. J Vasc Surg 2002;36:437–442.
AbuRahma AF, Wulu JT, Crotty B. Carotid plaque ultrasonic heterogeneity and severity of stenosis. Stroke 2002;33:1772–1775.
Choo V. New imaging technology might help prevent stroke. Lancet 1998;351:809.
Kern R, Szabo K. Hennerici M, Meairs S. Characterization of carotid artery plaques using real-time compound Bmode ultrasound. Stroke 2004;35:870–875.
Biasi GM, Sampaolo A, Mingazzini P, De Amicis P. El-Barghouty N, Nicolaides AN. Computer analysis of ultrasonic plaque echolucency in identifying high-risk carotid bifurcation lesions. Eur J Vasc Endovasc Surg 1999;17:476–479.
Poli A, Tremoli E, Colombo A, Sirtori M, Pignoli P, Paoletti R. Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients. A new model for the quantitation and follow-up of preclinical atherosclerosis in living human subjects. Atherosclerosis 1988;70:253–261.
O’Leary DH, Polak JF, Kronmal RA, et al. Thickening of the carotid wall. A marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group. Stroke 1996;27:224–231.
Polak JF, O’Leary DH, Kronmal RA, et al. Sonographic evaluation of carotid artery atherosclerosis in the elderly: Relationship of disease severity to stroke and transient ischemic attack. Radiology 1993;188:363–370.
O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999;340:14–22.
Fry WR, Dort JA, Smith RS, et al. Duplex scanning replaces arteriography and operative exploration in the diagnosis of potential cervical vascular injury. Am J Surg 1994;168:693–696.
Steinke W. Schwartz A, Hennerici M. Doppler color flow imaging of common carotid artery dissection. Neuroradiology 1990;32(6):502–505.
Sturzenegger M. Ultrasound findings in spontaneous carotid artery dissection. The value of duplex sonography. Arch Neurol 1991;48(10):1057–1063.
Cals N, Devuyst G, Jung DK, Afsar N, de Freitas G, Despland PA, Bogousslavsky J. Uncommon ultrasound findings in traumatic extracranial dissection. Eur J Ultrasound 2001;12:227–231.
Keller HM, Meier WE, Kumpe DA. Noninvasive angiography for the diagnosis of vertebral artery disease using Doppler ultrasound (vertebral artery Doppler). Stroke 1976;7:364–369.
Kaneda H, Irino T, Minami T, et al. Diagnostic reliability of the percutaneous ultrasonic Doppler technique for vertebral arterial occlusive diseases. Stroke 1977;8:571–579.
Bartels E, Fuchs HH, Flugel KA. Color Doppler imaging of vertebral arteries: A comparative study with duplex ultrasonography. In: Oka M, et al. (eds). Recent Advantages in Neurosonology. Amsterdam: Elsevier Science Publishers, 1992.
De Bray JM. Le duplex des axes verebro-sous-claviers. J Echographie Med Ultrasons 1991;12:141–151.
Schmidt WA, Kraft HE,Vorpahl K, et al. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 1997;337:1336–1342.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer-Verlag London Limited
About this chapter
Cite this chapter
AbuRahma, A.F. (2010). Clinical Implications of the Vascular Laboratory in the Diagnosis of Cerebrovascular Insufficiency. In: AbuRahma, A.F., Bergan, J.J. (eds) Noninvasive Cerebrovascular Diagnosis. Springer, London. https://doi.org/10.1007/978-1-84882-957-2_13
Download citation
DOI: https://doi.org/10.1007/978-1-84882-957-2_13
Publisher Name: Springer, London
Print ISBN: 978-1-84882-956-5
Online ISBN: 978-1-84882-957-2
eBook Packages: MedicineMedicine (R0)