Accuracy and Prognostic Consequences of Ultrasonography in Identifying Severe Carotid Artery Stenosis

Eliasziw, Michael; Rankin, Richard N.; Aj, Fox; Haynes, R. Brian; Barnett, H. J. M.

doi:10.1161/01.str.26.10.1747

Cited by 165 publications

(99 citation statements)

References 42 publications

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“…The stroke registrar and nurse triage referrals on a daily basis, with priority appointments for patients with ipsilateral internal carotid artery stenosis ≥50%, a conservative threshold chosen to avoid missing a critical stenosis attributable to ultrasound misclassification. 18 For patients with ≥50% ipsilateral internal carotid artery stenosis, confirmatory computed tomography angiography or contrast-enhanced magnetic resonance angiography is arranged within 24 hours. Immediate referral for surgical intervention occurs for patients with confirmed symptomatic stenosis ≥70%.…”

Section: M3t Modelmentioning

confidence: 99%

Monash Transient Ischemic Attack Triaging Treatment

Sanders

Srikanth

Jolley

et al. 2012

Stroke

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Background and Purpose-Controversy surrounds the need for routine hospital admission for transient ischemic attack.The Monash Transient Ischemic Attack Triaging Treatment (M3T) model adopts rapid management in the emergency department followed by outpatient management prioritized by stroke mechanism. We compared safety and processes of care between M3T and the previous model of routine admission. Methods-Study cohorts consisted of patients managed with M3T (2004-2007) and the previous model (2003)(2004). We determined 90-day stroke outcome using clinical and medical record review and data linkage to the population level statewide hospital discharge morbidity database. We compared models of care using risk difference analysis, followed by logistic regression to adjust for previous indicators of risk. Secondary outcomes were proportions admitted, proportions undergoing carotid ultrasound, times to ultrasound and revascularization, and medication prescription. Results-In M3T (mean age, 64.7±14.7) 85/488 (17.4%) patients were admitted compared with 117/169 (62.9%) in the previous model (mean age, 72.5±13.9). With near-complete follow-up, 90-day stroke outcome was 1.50% (95% confidence interval, 0.73%-3.05%) in M3T and 4.67% (95% confidence interval, 2.28%-9.32%) in the previous model (P=0.03). Compared with the previous model, the adjusted odds ratio of stroke for M3T was 0.46 (95% confidence interval, 0.12-1.68; P=0.24). M3T was associated with greater proportions undergoing carotid ultrasound (P<0.001) and receiving antiplatelet therapy (P=0.005). Conclusions-The M3T system was associated with low 90-day stroke outcome in transient ischemic attack patients, providing proof of concept that these patients may be managed safely without routine hospital admission using a closely supervised protocol in the emergency department. (Stroke. 2012;43:2936-2941.)

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Section: M3t Modelmentioning

confidence: 99%

Monash Transient Ischemic Attack Triaging Treatment

Sanders

Srikanth

Jolley

et al. 2012

Stroke

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“…Moreover, conventional angiography is also associated with an increased risk of thromboembolic events. 19 Consequently, noninvasive techniques, such as ultrasound (US) echo color Doppler (US-ECD), 20,21 MR, 22,23 and CT angiography (CTA) 18,24 have been more and more frequently used to study carotid artery pathology.…”

mentioning

confidence: 99%

CT and Ultrasound in the Study of Ulcerated Carotid Plaque Compared with Surgical Results: Potentialities and Advantages of Multidetector Row CT Angiography

Saba

Caddeo²,

Sanfilippo³

et al. 2007

American Journal of Neuroradiology

197

120

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“…[12][13][14][15][16][17][18] However, in a nonselected population of 1011 symptomatic patients from the NASCET, sensitivity and specificity for detecting 70 to 99% carotid stenosis were only 0.68 and 0.67, respectively, and even more important, PSV values did not correlate with the risk of stroke. 19 This indicates that patient selection cannot be performed on PSV values alone. Therefore, if ultrasonography is used for patient selection, additional means for quantifying lumen reduction seem required.…”

mentioning

confidence: 99%

Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography.

Elgersma

Leeuwen

Meijer

et al. 1999

Journal of Ultrasound in Medicine

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Our aim was to assess reproducibility of three different lumen reduction measuring methods‐‐North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid‐‐using power Doppler and color Doppler sonography before and after Levovist enhancement. We included 20 symptomatic patients with mild or severe carotid disease. North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid measurements on longitudinal views and European Carotid Surgery Trial measurements on transverse views were performed. Examinations were repeated and the results compared to assess reproducibility of measurements. Correlation with angiography was obtained by calculating Pearson correlation coefficients. Reproducibility was significantly better (P < 0.05) for European Carotid Surgery Trial and common carotid measurements (95% limits of agreement between ‐10% to 10% and ‐19% to 17%) as compared to North American Symptomatic Carotid Endarterectomy Trial measurements (95% limits of agreement between ‐11% to 21% and ‐21% to 23%). Variability of measurements after enhancement increased slightly (not significant) for both power and color Doppler sonography. Additionally, European Carotid Surgery Trial measurements, using nonenhanced power Doppler or color Doppler sonography, did not correlate significantly with angiography, whereas North American Symptomatic Carotid Endarterectomy Trial and common carotid measurements correlated well with angiography, particularly in power Doppler mode after enhancement (r = 0.88 and r = 0.82, respectively). We conclude that for lumen reduction measurements of the internal carotid artery with power and color Doppler sonography, the common carotid method is the only method that is reproducible and has good correlation with angiography, which slightly improves after Levovist enhancement.

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Accuracy and Prognostic Consequences of Ultrasonography in Identifying Severe Carotid Artery Stenosis

Cited by 165 publications

References 42 publications

Monash Transient Ischemic Attack Triaging Treatment

Monash Transient Ischemic Attack Triaging Treatment

CT and Ultrasound in the Study of Ulcerated Carotid Plaque Compared with Surgical Results: Potentialities and Advantages of Multidetector Row CT Angiography

Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography.

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