Comparison of Carotid Stenosis Grading by CT Angiography and Doppler Ultrasonography: How the Statistical Methods Applied Influence the Results

Samaržija, Kristina; Milošević, Petar; Jurjević, Zoran; Erdeljac, Emilija

doi:10.20471/acc.2021.60.03.17

Cited by 1 publication

(1 citation statement)

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“…Although the NASCET measurement protocol involves linear measurements, and our expert reviewers strictly followed NASCET protocol, a subset of operators used the analytic packages built into their fluoroscopy systems to calculate percent stenosis based on an estimated cross-sectional area (eg, using linear measurements from corresponding anterior-posterior and lateral images obtained just before stent placement). As has been demonstrated by other studies examining the use of cross-sectional area recorded from noninvasive tests, 14–16 generating analogous area measurements obtained from invasive imaging tends to overestimate stenosis as compared with the strict NASCET technique. Furthermore, NASCET criteria cannot be applied to stenosis of the CCA, and considerable variability was noted in how both operators and reviewers measured stenosis in the subset of patients with CCA pathology.…”

Section: Discussionmentioning

confidence: 68%

Variation in Carotid Artery Stenosis Measurements Among Facilities Seeking Carotid Stenting Facility Accreditation

Jareczek

Farrell²,

Lehman

et al. 2023

Stroke

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Background: Based on the inclusion criteria of clinical trials, the degree of cervical carotid artery stenosis is often used as an indication for stent placement in the setting of extracranial carotid atherosclerotic disease. However, the rigor and consistency with which stenosis is measured outside of clinical trials are unclear. In an agreement study using a cross-sectional sample, we compared the percent stenosis as measured by real-world physician operators to that measured by independent expert reviewers. Methods: As part of the carotid stenting facility accreditation review, images were obtained from 68 cases of patients who underwent carotid stent placement. Data collected included demographics, stroke severity measures, and the documented degree of stenosis, termed operator-reported stenosis (ORS), by 34 operators from 14 clinical sites. The ORS was compared with reviewer-measured stenosis (RMS) as assessed by 5 clinicians experienced in treating carotid artery disease. Results: The median ORS was 90.0% (interquartile range, 80.0%–90.0%) versus a median RMS of 61.1% (interquartile range, 49.8%–73.6%), with a median difference of 21.8% (interquartile range, 13.7%–34.4%), P <0.001. The median difference in ORS and RMS for asymptomatic versus symptomatic patients was not statistically different (24.6% versus 19.6%; P =0.406). The median difference between ORS and RMS for facilities granted initial accreditation was smaller compared with facilities whose accreditation was delayed (17.9% versus 25.5%, P =0.035). The intraclass correlation between ORS and RMS was 0.16, indicating poor agreement. If RMS measurements were used, 72% of symptomatic patients and 10% of asymptomatic patients in the population examined would meet the Centers for Medicare and Medicaid Services criteria for stent placement. Conclusions: Real-world operators tend to overestimate carotid artery stenosis compared with external expert reviewers. Measurements from facilities granted initial accreditation were closer to expert measurements than those from facilities whose accreditation was delayed. Since decisions regarding carotid revascularization are often based on percent stenosis, such measuring discrepancies likely lead to increased procedural utilization.

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Section: Discussionmentioning

confidence: 68%