Cross-sectional area for the calculation of carotid artery stenosis on computed tomographic angiography

Stone, Jonathan; Doyle, Adam J.; Chowdhry, Amit K.; Mix, Doran; Ellis, Jennifer L.; Gillespie, David L.; Chandra, Ankur

doi:10.1016/j.jvs.2013.02.031

Cited by 26 publications

(27 citation statements)

References 25 publications

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“…Carnicelli et al tested the accuracy of CTA using CDUS as a surrogate for true stenosis, and came to the conclusion that there is no significant difference between diameter and area measurements [6]. Bartlett et al, testing diameter and area measurements, concluded that carotid stenosis quantification based upon the narrowest diameter reliably predicts the more precise area measurements [7].…”

Section: Discussionmentioning

confidence: 99%

Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area

et al. 2018

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ObjectivesTo compare the estimation of carotid artery stenosis by computed tomography angiography (CTA) based on cross-sectional area versus the smallest diameter measurement, and test the accuracy of both CTA measurements using color Doppler ultrasonography (CDUS) as a reference method.MethodsFor 113 carotid arteries with stenosis ≥50% we analysed the differences in the estimated stenosis level between both CTA methods and CDUS using the Bland-Altman approach. Further, we calculated sensitivity, specificity and plotted receiver operating characteristic (ROC) curves for both CTA methods.ResultsThe mean difference between CDUS and CTA (area) measurements was −0.4% (p = 0.68); between CDUS and CTA (diameter), 20.7% (p < 0.001); and between CTA (area) and CTA (diameter), 21.2% (p < 0.001). Sensitivity and specificity for the CTA (area) method were 81% and 77%, and for CTA (diameter) were 23% and 100%. The area under the curve (AUC) for CTA (diameter) was 0.62 (0.57, 0.66), and for CTA (area) 0.79 (0.71–0.87). The equality test for the two AUCs was <0.0001.ConclusionsCTA (diameter)-based measurements significantly underestimated the degree of carotid stenosis. We recommend the CTA (area) method because of its higher predictive power for a correct stenosis classification and a lack of significant difference in the estimated stenosis level, compared to CDUS.Main messages• Cross-sectional area measurement considers asymmetric shape of the residual vessel lumen.• CTA (diameter) method on average significantly underestimates the true level of stenosis.• CTA (area) method correctly classifies vessels needing surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area

et al. 2018

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“…The stenosis of the contralateral carotid artery was determined in CTA and mainly obtained from axial images using the North American Symptomatic Carotid Endarterectomy Trial equation [29]. All centers used a bolus-triggering technique with region of interest in the ascending aorta at the beginning of the aortic arch.…”

Section: Methodsmentioning

confidence: 99%

Carotid Artery Stenosis Contralateral to Acute Tandem Occlusion: An Independent Predictor of Poor Clinical Outcome after Mechanical Thrombectomy with Concomitant Carotid Artery Stenting

Maus

Behme²,

Borggrefe

et al. 2017

Cerebrovasc Dis

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Background and Purpose: Cerebral ischemic strokes due to extra-/intracranial tandem occlusions (TO) of the anterior circulation are responsible for causing mechanical thrombectomy (MT). The impact of concomitant contralateral carotid stenosis (CCS) upon outcome remains unclear in this stroke subtype. Methods: Retrospective analysis of prospectively collected data of 4 international stroke centers between 2011 and 2017. One hundred ninety-seven consecutive patients with anterior TO were treated with MT and acute carotid artery stenting (CAS). Clinical (including demographics and National Institutes of Health Stroke Scale [NIHSS]), imaging (including angiographic evaluation of CCS) and procedural data were evaluated. Favorable clinical outcome was defined as modified Rankin Scale (mRS) ≤2 at 90 days. Results: In 186 out of 197 TO patients preinterventional CT angiography was available for analysis, thereof 49 patients (26%) presented with CCS. Median admission NIHSS and procedural timings did not differ between groups. Reperfusion was successful in 38 out of 49 patients (78%) vs. 113 out of 148 patients (76%) without CCS. In stark contrast, rate of favorable outcome at 90 days differed significantly between groups (22 vs. 44%; p < 0.05). The presence of CCS in TO was associated with an unfavorable clinical outcome independent of age and NIHSS in multivariate logistic regression (p < 0.05). Final infarct volume was significantly larger in CCS patients (100 ± 127 vs. 63 ± 77 cm³; p < 0.05). Neither all-cause mortality rates (25 vs. 17%) nor frequency of peri-interventional symptomatic intracranial hemorrhage differed between groups (7 vs. 6%). Conclusion: For patients with anterior TO undergoing MT with concomitant CAS the presence of CCS >50% is an independent predictor of poor clinical outcome. This most likely cause is due to poorer collateral flow to the affected tissue.

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“…UoW criteria. The UoW criteria [10][11][12] combine PSVs and end-diastolic velocities to classify stenosis. A stenosis of 50% to 79% is indicated by a PSV >125 cm/s and an end-diastolic velocity <140 cm/s; a stenosis $80% is indicated by a PSV >125 cm/s and an end-diastolic velocity $140 cm/s.…”

Section: Dusmentioning

confidence: 99%

Assessing internal carotid artery stenosis with a semiautomated computed tomography angiography tool and duplex ultrasound

Müller

Agten

Österreich

et al. 2015

Journal of Vascular Surgery

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Cross-sectional area for the calculation of carotid artery stenosis on computed tomographic angiography

Cited by 26 publications

References 25 publications

Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area

Grading of carotid artery stenosis with computed tomography angiography: whether to use the narrowest diameter or the cross-sectional area

Carotid Artery Stenosis Contralateral to Acute Tandem Occlusion: An Independent Predictor of Poor Clinical Outcome after Mechanical Thrombectomy with Concomitant Carotid Artery Stenting

Assessing internal carotid artery stenosis with a semiautomated computed tomography angiography tool and duplex ultrasound

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