The role of carotid duplex scanning in surgical decision making

Abstract

Eighty-one patients suspected of having cerebrovascular disease had 157 carotid arterial systems studied by both duplex ultrasonography and contrast arteriography to better define the role of carotid duplex scanning in the surgical decision-making process. These studies were reviewed in a blinded fashion in conjunction with history and physical examination data by two surgeons, one operating on only symptomatic lesions, the other operating on both symptomatic and asymptomatic lesions. Results were analyzed to ascertain if there was agreement regarding decisions for carotid endarterectomy based on scan findings compared with decisions based on arteriographic findings. Scans were also compared with arteriograms and data were analyzed by decision matrix analysis. The accuracy of duplex scanning in relation to arteriography was 81% for detection of disease, 90% for the detection of ulceration, 83% for the detection of a critical stenosis, and 99% for the detection of total arterial occlusion. There was agreement between the two studies regarding the need for carotid surgery in 91% and 89% of carotid arteries, according to surgeons A and B, respectively. Regardless of the surgeons' indications for carotid endarterectomy, duplex ultrasonography provides sufficient information for proper surgical decision making in a high percentage of patients. The accuracy of duplex scanning and the risks of contrast arteriography suggest a possible future role for the routine use of duplex ultrasonography with selective utilization of arteriography in the surgical decision-making process in patients being evaluated for cerebrovascular occlusive disease.

Doppler Velocity Criteria Based on Receiver Operating Characteristic Analysis for the Detection of Threshold Carotid Stenoses

“…Nearly all of the previous ultrasound criteria not based on these endarterectomy trials have been gradually discarded. 6,[18][19][20][21][22][23][24] Among the new ultrasound criteria, absolute Doppler velocity criteria proved the most promising for the detection of threshold carotid stenoses. [6][7][8] However, criteria were quite divergent among these studies and some of their study methods are still being debated.…”

Disease progression in contralateral carotid artery is common after endarterectomy

“…3 The accuracy of duplex ultrasound scanning in evaluating carotid artery disease has been reported as having sensitivity of 99% and specificity of 84%. 5,6 We sought to review the natural history of disease progression in the contralateral carotid artery in patients who underwent CEA and were surveilled with duplex ultrasound scanning; imaging of both carotid arteries was performed at each visit. This allowed us to study both disease progression in the contralateral carotid artery and recurrent stenosis in the ipsilateral carotid artery.…”

Modern Imaging in the Management of Cervical Carotid Stenosis

“…We mention digital subtraction angiography (DSA) first because it is the test by which all others are measured. [4][5][6][7][8][9][10][11][12][13] Prior to the advent of newer techniques, conventional angiography was the test of choice for most neck vessel and cerebral pathology. 14 The majority of the early work in conventional angiography was completed by Egas Moniz as early as 1927.…”

“…Flanigan et al, in a blinded study of 157 carotid artery systems, compared the relative accuracies of carotid DUS with contrast arteriography. 6 They showed that, relative to arteriography, DUS was 81% accurate in the detection of disease, 83% accurate in the detection of critical stenosis, 90% accurate in the detection of ulceration, and 99% accurate in the detection of complete occlusion. They concluded that DUS was capable of providing accurate information for surgical decision making in a high percentage of patients, with limited application of arteriography when insufficient information is present.…”