Stroke, Vol 25, 2435-2439, Copyright © 1994 by American Heart Association
PM Rothwell, RJ Gibson, J Slattery, RJ Sellar and CP Warlow
BACKGROUND AND PURPOSE: There is confusion about how carotid stenosis
should be measured on angiograms. If the results of research based on
different methods of measurement of stenosis are to be discussed and the
results of clinical trials properly applied to routine clinical practice,
measurements made by the different methods must be formally compared.
METHODS: The method of measurement of stenosis used in the European Carotid
Surgery Trial (ECST), that used in the North American Symptomatic Carotid
Endarterectomy Trial (NASCET), and a method based on measurement of the
common carotid (CC) artery lumen diameter were compared. Carotid stenosis
was measured by two observers, working independently and using the three
different methods of measurement, on the angiographic view of the
symptomatic carotid stenosis that showed the most severe disease in 1001
patients from the ECST. RESULTS: The results of using the ECST and CC
methods differed from those of using the NASCET method in the
classification of stenoses as mild (0% to 29%), moderate (30% to 69%), or
severe (70% to 99%) in 51% of measurements. The ECST and CC methods
indicated that twice as many stenoses were severe as did the NASCET method,
and classified less than a third of the number of stenoses as mild. The
results of the ECST and CC methods differed from each other in 15% of
measurements. The relations between measurements made by each method to
those made by the others were approximately linear, so a simple equation
could be derived to convert measurements made by one method to measurements
made by the others. CONCLUSIONS: There were major and clinically important
disparities between measurements of stenosis made using different methods
of measurement on the same angiograms. However, it is possible to convert
measurements made by one method to those of another using a simple
arithmetic equation.
ARTICLES
Equivalence of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative Group
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, Scotland.
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