This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Fredericks, R. K. Articles by Troost, B. T. Search for Related Content PubMed PubMed Citation Articles by Fredericks, R. K. Articles by Troost, B. T. Pubmed/NCBI databases Medline Plus Health Information Carotid Artery Disease

Stroke, Vol 21, 476-479, Copyright © 1990 by American Heart Association

ARTICLES

Implications of the angiographic string sign in carotid atherosclerosis

RK Fredericks, TD Thomas, DS Lefkowitz and BT Troost
Department of Neurology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27103.

We identified 60 patients (42 men and 18 women with an average age of 62.6 years) with angiographically documented carotid stenoses of greater than or equal to 95%; a string sign was demonstrated in 28. Twenty of the 60 patients (33%) were asymptomatic on presentation, 26 (43%) had hemispheric transient ischemic attacks, 21 (35%) had amaurosis fugax, and nine (15%) had previous ipsilateral infarctions. Demographics, mode of presentation, and prevalence of atherosclerotic risk factors were not significantly different between patients with and without a string sign. Doppler frequencies recorded in patients with a string sign were less than 6 or greater than 16 KHz. Real-time ultrasonography imaged a patent lumen in all but three cases with a string sign. Surgery was performed in 26 patients with a string sign and in 21 patients without a string sign. The rate of major perioperative complications was not influenced by the presence of a string sign, contralateral extracranial stenosis, or ipsilateral siphon stenosis. Average lumen size of the endarterectomy specimens was 0.94 mm in those with and 1.7 mm in those without a string sign. We conclude that combined noninvasive testing has a sensitivity of 83% for demonstrating a residual lumen in patients with greater than or equal to 95% carotid stenosis and that the angiographic string sign does not affect the mode of presentation or surgical outcome of these patients.

This article has been cited by other articles:

				C. H. Wierks and N. Labropoulos Noninvasive Carotid Imaging Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2004; 16(2): 89 - 99. [Abstract] [PDF]

				G. Furst, A. Saleh, F. Wenserski, J. Malms, M. Cohnen, A. Aulich, T. Neumann-Haefelin, M. Schroeter, H. Steinmetz, and M. Sitzer Reliability and Validity of Noninvasive Imaging of Internal Carotid Artery Pseudo-Occlusion Stroke, July 1, 1999; 30(7): 1444 - 1449. [Abstract] [Full Text] [PDF]

				M. A. Martin and T. R. Marotta Vasa Vasorum: Another Cause of the Carotid String Sign AJNR Am. J. Neuroradiol., February 1, 1999; 20(2): 259 - 262. [Abstract] [Full Text]

				J. N. Pappas The Angiographic String Sign Radiology, January 1, 2002; 222(1): 237 - 238. [Full Text] [PDF]