Stroke, Vol 25, 2440-2444, Copyright © 1994 by American Heart Association
PM Rothwell, RJ Gibson, J Slattery and CP Warlow
BACKGROUND AND PURPOSE: The use of three methods of measuring carotid
stenosis, which produce different values on the same angiograms, has caused
confusion and reduced the generalizability of the results of research. If
the results of future studies are to be properly applied to clinical
practice, and if noninvasive methods of imaging are to be properly
validated against angiography, a single, standard method of measurement of
stenosis on angiograms must be adopted. This standard method should be
selected on the bases of its ability to predict risk of ipsilateral carotid
distribution ischemic stroke and its reproducibility. METHODS: The method
of measurement of carotid 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 the measurement of the
common carotid (CC) lumen diameter were studied. Their use in the
prediction of ipsilateral carotid distribution ischemic stroke was assessed
in 1001 consecutively selected patients randomly assigned to medical
treatment in the ECST. Carotid stenosis was measured by two observers
working independently, using all three methods, on the angiographic view
that showed the most severe stenosis of the symptomatic carotid
bifurcation. Interobserver agreement was determined, and 50 angiograms were
remeasured to determine intraobserver agreement. RESULTS: There was little
difference in the ability of the three methods to predict ipsilateral
carotid distribution ischemic stroke. The CC method was consistently the
most reproducible of the three, particularly for stenosis in the clinically
important range of 50% to 90%. CONCLUSIONS: The CC method of measurement
should be adopted as the standard method of measuring the degree of carotid
stenosis on angiograms.
ARTICLES
Prognostic value and reproducibility 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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