Stroke, Vol 24, 1513-1518, Copyright © 1993 by American Heart Association
M Sitzer, G Furst, H Fischer, M Siebler, T Fehlings, A Kleinschmidt, T Kahn and H Steinmetz
BACKGROUND AND PURPOSE: The degree of internal carotid stenosis has emerged
as the most important predictor of ischemic stroke in extracranial carotid
artery disease. The purpose of this study was to assess the validity of the
noninvasive techniques for quantifying internal carotid stenosis with
respect to the accepted standard of intra-arterial angiography. METHODS: We
measured the maximum percentage reduction in luminal diameter on the
intra-arterial digital subtraction angiograms of 56 symptomatic patients
with extracranial internal carotid stenosis (n = 77) or occlusion (n = 20).
These data were compared with independent measurements based on
continuous-wave Doppler ultrasonography, pulsed-wave Doppler spectrum
analysis, color Doppler- assisted duplex imaging, and magnetic resonance
angiography. RESULTS: Correlations with intra-arterial angiography were
equally strong (r > .90) for magnetic resonance angiography,
continuous-wave Doppler, and color duplex analysis. Positive and negative
predictive values for (therapeutically relevant) 70% to 99% stenosis were
higher for continuous-wave Doppler (.82, .97) and color duplex (.84, .98)
than for magnetic resonance angiography (.79, .81). Also, accuracy in
quantifying high-grade stenosis was better for both of these
ultrasonographic techniques, mainly due to the frequent occurrence of a
"flow gap" on the magnetic resonance angiograms. Continuous-wave Doppler
and magnetic resonance angiography, but not color duplex, failed to detect
slow residual arterial flow in one and two cases of symptomatic
"pseudo-occlusion" of the internal carotid, respectively. CONCLUSIONS: (1)
Several noninvasive methods compare well with intra- arterial angiography
in identifying and quantifying high-grade internal carotid stenosis; (2)
the use of these noninvasive methods may suffice for treatment decisions;
and (3) because residual between-method disagreement is partly explained by
principles of physics, the validity of continuous-wave Doppler and color
duplex in quantifying 60% to 99% stenosis is likely to be underestimated by
correlation with intra- arterial angiography.
ARTICLES
Between-method correlation in quantifying internal carotid stenosis
Department of Neurology, Heinrich-Heine-University, Dusseldorf, Germany.
This article has been cited by other articles:
 |
|
 |
|
  S. M. Debrey, H. Yu, J. K. Lynch, K.-O. Lovblad, V. L. Wright, S.-J. D. Janket, and A. E. Baird Diagnostic Accuracy of Magnetic Resonance Angiography for Internal Carotid Artery Disease: A Systematic Review and Meta-Analysis Stroke, August 1, 2008; 39(8): 2237 - 2248. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Wessels, J. U. Harrer, S. Stetter, M. Mull, and C. Klotzsch Three-Dimensional Assessment of Extracranial Doppler Sonography in Carotid Artery Stenosis Compared With Digital Subtraction Angiography Stroke, August 1, 2004; 35(8): 1847 - 1851. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. W. Lien, A. H. Lee, Y. Kono, G. C. Steinbach, and R. F. Mattrey Noninvasive Estimation of the Pressure Gradient Across Stenoses Using Sonographic Contrast: In Vitro Validation J. Ultrasound Med., May 1, 2004; 23(5): 683 - 691. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Schillinger, M. Exner, W. Mlekusch, H. Rumpold, R. Ahmadi, S. Sabeti, W. Lang, O. Wagner, and E. Minar Acute-Phase Response after Stent Implantation in the Carotid Artery: Association with 6-month In-Stent Restenosis Radiology, May 1, 2003; 227(2): 516 - 521. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Sitzer, D. Puac, A. Buehler, D. A. Steckel, S. von Kegler, H. S. Markus, and H. Steinmetz Internal Carotid Artery Angle of Origin: A Novel Risk Factor for Early Carotid Atherosclerosis Stroke, April 1, 2003; 34(4): 950 - 955. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Jerrard-Dunne, M. Sitzer, P. Risley, D. A. Steckel, A. Buehler, S. von Kegler, and H. S. Markus Interleukin-6 Promoter Polymorphism Modulates the Effects of Heavy Alcohol Consumption on Early Carotid Artery Atherosclerosis: The Carotid Atherosclerosis Progression Study (CAPS) Stroke, February 1, 2003; 34(2): 402 - 407. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E Westwood, S. Kelly, E. Berry, J. M Bamford, M. J Gough, C M. Airey, J. F M Meaney, L. M Davies, J. Cullingworth, and M. A Smith Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review BMJ, January 26, 2002; 324(7331): 198 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Dietz, J. Berkefeld, J. G. Theron, T. Schmitz-Rixen, F. E. Zanella, B. Turowski, H. Steinmetz, and M. Sitzer Endovascular Treatment of Symptomatic Carotid Stenosis Using Stent Placement: Long-Term Follow-Up of Patients With a Balanced Surgical Risk/Benefit Ratio Stroke, August 1, 2001; 32(8): 1855 - 1859. [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]
|
|
|
|
 |
|
 H. S. Markus, M. Sitzer, D. Carrington, M. A Mendall, and H. Steinmetz Chlamydia pneumoniae Infection and Early Asymptomatic Carotid Atherosclerosis Circulation, August 24, 1999; 100(8): 832 - 837. [Abstract] [Full Text] [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]
|
|
|
|
|
|
R. W. Baumgartner, H. P. Mattle, and G. Schroth Assessment of >=50% and <50% Intracranial Stenoses by Transcranial Color-Coded Duplex Sonography Stroke, January 1, 1999; 30(1): 87 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W Baumgartner and I. Baumgartner Vasomotor reactivity is exhausted in transient ischaemic attacks with limb shaking J. Neurol. Neurosurg. Psychiatry, October 1, 1998; 65(4): 561 - 564. [Abstract] [Full Text]
|
|
|
|
|
|
W. Steinke, S. Ries, N. Artemis, A. Schwartz, and M. Hennerici Power Doppler Imaging of Carotid Artery Stenosis : Comparison With Color Doppler Flow Imaging and Angiography Stroke, October 1, 1997; 28(10): 1981 - 1987. [Abstract] [Full Text]
|
|
|
|
|
|
N. Suwanwela, U. Can, K. L. Furie, J. F. Southern, N. R. Macdonald, C. S. Ogilvy, C. J. Hansen, F. S. Buonanno, W. M. Abbott, W. J. Koroshetz, et al. Carotid Doppler Ultrasound Criteria for Internal Carotid Artery Stenosis Based on Residual Lumen Diameter Calculated From En Bloc Carotid Endarterectomy Specimens Stroke, November 1, 1996; 27(11): 1965 - 1969. [Abstract] [Full Text]
|
|
|
|
|
|
J. L. Wilterdink, E. Feldmann, J. D. Easton, and R. Ward Performance of Carotid Ultrasound in Evaluating Candidates for Carotid Endarterectomy Is Optimized by an Approach Based on Clinical Outcome Rather Than Accuracy Stroke, June 1, 1996; 27(6): 1094 - 1098. [Abstract] [Full Text]
|
|
|
|
|
|
P. Zunker, A. Schick, H.-C. Buschmann, D. Georgiadis, D. G. Nabavi, M. Edelmann, and E. B. Ringelstein Hyperinsulinism and Cerebral Microangiopathy Stroke, February 1, 1996; 27(2): 219 - 223. [Abstract] [Full Text]
|
|
|
|
|
|
W. Steinke, S. Meairs, S. Ries, and M. Hennerici Sonographic Assessment of Carotid Artery Stenosis : Comparison of Power Doppler Imaging and Color Doppler Flow Imaging Stroke, January 1, 1996; 27(1): 91 - 94. [Abstract] [Full Text]
|
|
|
|
|
|
B. Griewing, C. Morgenstern, F. Driesner, G. Kallwellis, M.L. Walker, and C. Kessler Cerebrovascular Disease Assessed by Color-Flow and Power Doppler Ultrasonography : Comparison With Digital Subtraction Angiography in Internal CarotidArtery Stenosis Stroke, January 1, 1996; 27(1): 95 - 100. [Abstract] [Full Text]
|
|
|
|
 |
|
 P.J. Martin, M.E. Gaunt, P.R.F. Bell, and A.R. Naylor Extracranial and Transcranial Color-Coded Sonography Reduce the Need for Angiography Prior to Carotid Endarterectomy Vascular and Endovascular Surgery, November 1, 1995; 29(6): 477 - 482. [Abstract] [PDF]
|
|
|
|
|
|
M. Siebler, A. Nachtmann, M. Sitzer, G. Rose, A. Kleinschmidt, J. Rademacher, and H. Steinmetz Cerebral Microembolism and the Risk of Ischemia in Asymptomatic High-Grade Internal Carotid Artery Stenosis Stroke, November 1, 1995; 26(11): 2184 - 2186. [Abstract] [Full Text]
|
|
|
|
|
|
M. R. Patel, K. M. Kuntz, R. A. Klufas, D. Kim, J. Kramer, J. F. Polak, J. J. Skillman, A. D. Whittemore, R. R. Edelman, and K. C. Kent Preoperative Assessment of the Carotid Bifurcation : Can Magnetic Resonance Angiography and Duplex Ultrasonography Replace Contrast Arteriography? Stroke, October 1, 1995; 26(10): 1753 - 1758. [Abstract] [Full Text]
|
|
|
|
|
|
P. J. Martin, M. E. Gaunt, S. Nydahl, and D. A. Ratliff Diagnosis of Internal Carotid Pseudo-occlusion by Use of Color-Coded Duplex Scanning: A Case Report Vascular and Endovascular Surgery, July 1, 1995; 29(4): 303 - 307. [Abstract] [PDF]
|
|