Stroke, Vol 25, 2445-2449, Copyright © 1994 by American Heart Association
M Eliasziw, RF Smith, N Singh, DW Holdsworth, AJ Fox and HJ Barnett
BACKGROUND AND PURPOSE: Three different methods for estimating the
percentage of reduction in the diameter of the internal carotid artery (ie,
stenosis) have been proposed in the literature. Further comparisons of the
methods were carried out with the intent of recommending a current standard
for determining the percentage of stenosis from angiograms. METHODS:
Angiograms from 112 patients were obtained. For each angiogram, stenosis
was estimated in the manner of the European Carotid Surgery Trial (ECST
method), the North American Symptomatic Carotid Endarterectomy Trial
(NASCET method), and by a method using the common carotid artery lumen
diameter (CC method). RESULTS: Although there is much discrepancy among the
estimates of stenosis arising from the three different methods for any
particular patient, it is possible to predict (on average) the percentage
of stenosis from one method to another. The relationship between the NASCET
and CC methods is linear, with a mean ratio of distal internal carotid
artery to common carotid diameter of 0.62 (SD of 0.11). The variability in
the diameter of the common carotid artery lumen stabilizes only beyond 2.5
common carotid diameter units (approximately 20 to 30 mm by conventional
angiography) proximal to the bifurcation. Unexpectedly, the relationships
between both the ECST and NASCET methods and ECST and CC methods were
parabolic (P < .001). The reasons underlying these departures from
linearity are uncertain. CONCLUSIONS: The comparability of our results with
those reported in the literature regarding the CC and NASCET methods
provides further evidence of the reproducibility of methods measuring
anatomic features that can be visualized on an angiogram. Disease of the
internal carotid artery is one of the important causes of ischemic
symptoms. Measuring the narrowest portion of the internal artery relative
to the normal portion of the same artery, well beyond the bulb, is a
logical method. Moreover, benefits of carotid endarterectomy for patients
with 70% to 99% stenosis as determined by the NASCET method have been well
established in a clinical trial. Converting from the NASCET method to the
CC method, given that the CC method is neither superior nor easier to
calculate, is not recommended.
ARTICLES
Further comments on the measurement of carotid stenosis from angiograms. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group
Department of Epidemiology and Biostatics, University of Western Ontario, London, Canada.
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