This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Eikelboom, B. C. Articles by Imparato, A. M. Search for Related Content PubMed PubMed Citation Articles by Eikelboom, B. C. Articles by Imparato, A. M.

Stroke, Vol 14, 882-885, Copyright © 1983 by American Heart Association

ARTICLES

Inaccuracy of angiography in the diagnosis of carotid ulceration

BC Eikelboom, TR Riles, R Mintzer, FG Baumann, G DeFillip, J Lin and AM Imparato

It is generally stated that ulceration of the carotid bifurcation plaque may give rise to embolization and symptoms of cerebral ischemia. It has been suggested that prophylactic carotid endarterectomy is indicated in asymptomatic patients if the angiogram is interpreted as showing ulceration. We therefore determined the accuracy of the radiologic diagnosis of ulceration by comparing the radiologic and morphologic findings in 155 carotid endarterectomies. Ulceration was diagnosed in 54% of the angiograms and 47% of the surgical specimens and was not related to the degree of stenosis. Angiography had a sensitivity of 73%, a specificity of 62% and an overall accuracy of 67%. For the non-flow-restrictive lesions these figures were 65%, 66%, and 66%. If surgery were based on the angiographic diagnosis of ulceration in plaques with less than 50% stenosis, 16 out of 42 operations (38%) would have been done unnecessarily. Variability of the angiographic diagnosis of ulceration is also shown by a high interobserver variability; two sets of two authors read the angiograms independently and disagreed in 24% of the cases. The decision to operate should not depend entirely upon the angiographic diagnosis of ulceration.

This article has been cited by other articles:

				J.K. Lovett, P.J. Gallagher, L.J. Hands, J. Walton, and P.M. Rothwell Histological Correlates of Carotid Plaque Surface Morphology on Lumen Contrast Imaging Circulation, October 12, 2004; 110(15): 2190 - 2197. [Abstract] [Full Text] [PDF]

				U. Schminke, L. Motsch, L. Hilker, and C. Kessler Three-Dimensional Ultrasound Observation of Carotid Artery Plaque Ulceration Stroke, July 1, 2000; 31(7): 1651 - 1655. [Abstract] [Full Text] [PDF]

				P. M. Rothwell, S. T. Pendlebury, J. Wardlaw, and C. P. Warlow Critical Appraisal of the Design and Reporting of Studies of Imaging and Measurement of Carotid Stenosis Stroke, June 1, 2000; 31(6): 1444 - 1450. [Abstract] [Full Text] [PDF]

				P. M. Rothwell, R. Gibson, and C. P. Warlow Interrelation Between Plaque Surface Morphology and Degree of Stenosis on Carotid Angiograms and the Risk of Ischemic Stroke in Patients With Symptomatic Carotid Stenosis Stroke, March 1, 2000; 31(3): 615 - 621. [Abstract] [Full Text] [PDF]

				G. E. Kim, Y. P. Cho, T. W. Kwon, H. S. Kim, H. S. Hong, and M. C. Lee B-mode Ultrasound Imaging in Symptomatic Internal Carotid Artery Stenosis: Correlation with Clinical and Operative Findings Vascular and Endovascular Surgery, November 1, 1999; 33(6): 611 - 616. [Abstract] [PDF]

				C. Estol, D. Claassen, W. Hirsch, L. Wechsler, and J. Moossy Correlative Angiographic and Pathologic Findings in the Diagnosis of Ulcerated Plaques in the Carotid Artery Arch Neurol, July 1, 1991; 48(7): 692 - 694. [Abstract] [PDF]

				W. L. Becker and R. M. Burde Carotid Artery Disease: A Therapeutic Enigma Arch Ophthalmol, January 1, 1988; 106(1): 34 - 39. [Abstract] [PDF]

				W. T. Longstreth Jr, T. D. Koepsell, and G. van Belle Clinical Neuroepidemiology: I. Diagnosis Arch Neurol, October 1, 1987; 44(10): 1091 - 1099. [Abstract] [PDF]

				M. I. Weintraub, D. Lambert, and A. L. Rothman Carotid Ultrasonography - The New "Gold Standard" Surgical and Angiographic Correlation Angiology, January 1, 1985; 36(1): 19 - 22. [Abstract] [PDF]