Stroke, Vol 24, 1292-1296, Copyright © 1993 by American Heart Association
AV Alexandrov, CF Bladin, R Maggisano and JW Norris
BACKGROUND AND PURPOSE: Data from recent multicenter carotid endarterectomy
trials have questioned the validity and reliability of Doppler ultrasound
in the assessment of carotid stenosis. METHODS: We prospectively analyzed
45 patients undergoing carotid angiography to compare the North American
Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid
Surgery Trial (ECST) methods of measuring carotid stenosis with those of
direct visualization ("eyeballing") and duplex ultrasound. Linear NASCET
and ECST measurements were also converted into area using the pi r2
function and termed "squared NASCET" (N2) and "squared ECST" (E2). In 15 of
45 patients undergoing carotid endarterectomy, the carotid plaque was
removed intact, sectioned, and photographed for computer measurement of
cross-sectional area. Comparison of this "gold standard" was then made to
each method of measurement. RESULTS: Comparison between duplex and the
various angiographic measurement techniques revealed significant
differences between NASCET and duplex (P < .0001), ECST and duplex (P
< .01), and E2 and duplex (P < .01) but not between N2, eyeballing,
and carotid duplex methods. Even the NASCET and ECST methods themselves
differed significantly (P < .006). When comparison was made with
computerized planimetric measurements of the carotid plaque, there were
significant differences for both NASCET (P < .0007) and ECST (P <
.007). Correlation was demonstrated only between planimetry and N2, E2, and
duplex. CONCLUSIONS: NASCET and ECST angiographic methods of measurement
consistently underestimate the "true" anatomic stenosis. As such, they
represent only "indexes" of carotid stenosis severity. Duplex provides a
more accurate measurement of carotid stenosis.
ARTICLES
Measuring carotid stenosis. Time for a reappraisal
Stroke Research Unit, Sunnybrook Health Science Centre, University of Toronto, Canada.
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