(Stroke. 1995;26:1747-1752.)
© 1995 American Heart Association, Inc.
Articles |
Accuracy and Prognostic Consequences of Ultrasonography in Identifying Severe Carotid Artery Stenosis
From the Departments of Epidemiology and Biostatistics (M.E.), Clinical Neurological Sciences (M.E., A.J.F., H.J.M.B.), and Diagnostic Radiology (R.N.R., A.J.F.), University of Western Ontario; The John P. Robarts Research Institute (M.E., H.J.M.B.), London, Ontario; and the Departments of Clinical Epidemiology and Biostatistics and of Medicine, McMaster University, Hamilton, Ontario (R.B.H.), Canada.
Correspondence to H.J.M. Barnett, The John P. Robarts Research Institute, 100 Perth Dr, London, Ontario, Canada, N6A 5K8.
Background and Purpose The accuracy of routine ultrasonography in detecting severe carotid artery stenosis was evaluated in comparison with cerebral angiography. The precision of ultrasonographic criteria in predicting the risk of stroke was also assessed.
Methods A total of 1011 symptomatic carotid bifurcations were studied in patients from the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Given that all patients were considered for entry into the trial, the chance of a verification bias affecting the analyses was minimized. The ultrasonographic data consisted of peak systolic velocities and frequency changes from both the internal and common carotid arteries. Angiographic stenosis was calculated as in NASCET. Receiver operating characteristic (ROC) curves were constructed from the ultrasonographic data for the detection of 70% or greater stenosis on the basis of an angiographic assessment. Kaplan-Meier stroke-free survival curves were used to predict the risk of stroke.
Results The areas under the ROC curves ranged from 0.74 to 0.75 (95% confidence interval [CI], 0.69 to 0.79). The sensitivities and specificities ranged from 0.65 to 0.71. The risk of stroke at 18 months declined sharply as the degree of angiographically defined stenosis declined from 99% to 70%. No pattern of decline was apparent on the basis of the ultrasonographic data.
Conclusions The results indicate that the accuracy of ultrasonography is moderate when flow parameters are used to assess the degree of stenosis. Ultrasonography should be used as a screening tool to exclude patients with no carotid artery disease from further testing. Conventional angiography remains an essential investigation before assigning the risk of stroke and deciding appropriate treatment for extracranial carotid artery disease.
Key Words: angiography • carotid arteries • carotid endarterectomy • ultrasonics
This article has been cited by other articles:
 |
|
 |
|
  M. U Farooq, A. Khasnis, A. Majid, and M. Y Kassab The role of optical coherence tomography in vascular medicine Vascular Medicine, February 1, 2009; 14(1): 63 - 71. [Abstract] [PDF]
|
|
|
|
 |
|
 E. S. Roach, M. R. Golomb, R. Adams, J. Biller, S. Daniels, G. deVeber, D. Ferriero, B. V. Jones, F. J. Kirkham, R. M. Scott, et al. Management of Stroke in Infants and Children: A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young Stroke, September 1, 2008; 39(9): 2644 - 2691. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Saba and G. Mallarini MDCTA of Carotid Plaque Degree of Stenosis: Evaluation of Interobserver Agreement Am. J. Roentgenol., January 1, 2008; 190(1): W41 - W46. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Saba, G. Caddeo, R. Sanfilippo, R. Montisci, and G. Mallarini CT and Ultrasound in the Study of Ulcerated Carotid Plaque Compared with Surgical Results: Potentialities and Advantages of Multidetector Row CT Angiography AJNR Am. J. Neuroradiol., June 1, 2007; 28(6): 1061 - 1066. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Davies, J. H. Rudd, and P. L. Weissberg Molecular and Metabolic Imaging of Atherosclerosis J. Nucl. Med., November 1, 2004; 45(11): 1898 - 1907. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J Ellul, P Talelli, G Terzis, A Chrysanthopoulou, G Gioldasis, and T Papapetropoulos Is the common carotid artery intima-media thickness associated with functional outcome after acute ischaemic stroke? J. Neurol. Neurosurg. Psychiatry, August 1, 2004; 75(8): 1197 - 1199. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. U-King-Im, R. A. Trivedi, M. J. Graves, N. J. Higgins, J. J. Cross, B. D. Tom, W. Hollingworth, H. Eales, E. A. Warburton, P. J. Kirkpatrick, et al. Contrast-enhanced MR angiography for carotid disease: Diagnostic and potential clinical impact Neurology, April 27, 2004; 62(8): 1282 - 1290. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Borisch, M. Horn, B. Butz, N. Zorger, B. Draganski, T. Hoelscher, U. Bogdahn, and J. Link Preoperative Evaluation of Carotid Artery Stenosis: Comparison of Contrast-Enhanced MR Angiography and Duplex Sonography with Digital Subtraction Angiography AJNR Am. J. Neuroradiol., June 1, 2003; 24(6): 1117 - 1122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Nederkoorn, Y. van der Graaf, and M.G. M. Hunink Duplex Ultrasound and Magnetic Resonance Angiography Compared With Digital Subtraction Angiography in Carotid Artery Stenosis: A Systematic Review Stroke, May 1, 2003; 34(5): 1324 - 1331. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Bilora, V. Boccioletti, F. Petrobelli, and A. Girolami Atherosclerosis and Secondary Deep Vein Thrombosis: A Difficult Correlation Clinical and Applied Thrombosis/Hemostasis, April 1, 2003; 9(2): 121 - 124. [Abstract] [PDF]
|
|
|
|
|
|
G. Schulte-Altedorneburg, D. W. Droste, S. Felszeghy, L. Csiba, V. Popa, K. Hegedus, J. Kollar, L. Modis, and E. B. Ringelstein Detection of Carotid Artery Stenosis by In Vivo Duplex Ultrasound: Correlation With Planimetric Measurements of the Corresponding Postmortem Specimens Stroke, October 1, 2002; 33(10): 2402 - 2407. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Nederkoorn, W. P.Th.M. Mali, B. C. Eikelboom, O. E.H. Elgersma, E. Buskens, M.G. M. Hunink, L. J. Kappelle, P. C. Buijs, A. F.J. Wust, A. van der Lugt, et al. Preoperative Diagnosis of Carotid Artery Stenosis: Accuracy of Noninvasive Testing Stroke, August 1, 2002; 33(8): 2003 - 2008. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. J.M. Barnett, H. E. Meldrum, and M. Eliasziw The appropriate use of carotid endarterectomy Can. Med. Assoc. J., April 1, 2002; 166(9): 1169 - 1179. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Logason, S. Karacagil, H.-G. Hardemark, A. Bostrom, A. Hellberg, and C. Ljungman Carotid Artery Endarterectomy Solely Based on Duplex Scan Findings Vascular and Endovascular Surgery, January 1, 2002; 36(1): 9 - 15. [Abstract] [PDF]
|
|
|
|
|
|
T. J. Tegos, K. J. Kalomiris, M. M. Sabetai, E. Kalodiki, and A. N. Nicolaides Significance of Sonographic Tissue and Surface Characteristics of Carotid Plaques AJNR Am. J. Neuroradiol., September 1, 2001; 22(8): 1605 - 1612. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Vergara, E. G. Grant, S. M. El Saden, and G. M. Hathout Duplex US for the Estimation of Internal Carotid Stenosis Drs Grant and colleagues respond: Radiology, May 1, 2001; 219(2): 575 - 577. [Full Text]
|
|
|
|
|
|
G. Manca, G. Parenti, R. Bellina, G. Boni, M. Grosso, W. Bernini, C. Palombo, M. Paterni, G. Pelosi, M. Lanza, et al. 111In Platelet Scintigraphy for the Noninvasive Detection of Carotid Plaque Thrombosis Stroke, March 1, 2001; 32(3): 719 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Koga, K. Kimura, K. Minematsu, and T. Yamaguchi Diagnosis of Internal Carotid Artery Stenosis Greater than 70% with Power Doppler Duplex Sonography AJNR Am. J. Neuroradiol., February 1, 2001; 22(2): 413 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Jager, I. S. Kritiansen, F. A. McAlister, S. E. Straus, G. H. Guyatt, and R. B. Haynes Helping Patients Integrate Research Evidence JAMA, November 22, 2000; 284(20): 2594 - 2595. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Serfaty, P. Chirossel, J. M. Chevallier, R. Ecochard, J. C. Froment, and P. C. Douek Accuracy of Three-Dimensional Gadolinium-Enhanced MR Angiography in the Assessment of Extracranial Carotid Artery Disease Am. J. Roentgenol., August 1, 2000; 175(2): 455 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. McAlister, S. E. Straus, G. H. Guyatt, R. B. Haynes, and for the Evidence-Based Medicine Working Group Users' Guides to the Medical Literature: XX. Integrating Research Evidence With the Care of the Individual Patient JAMA, June 7, 2000; 283(21): 2829 - 2836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Dix and J. Skrocki Evaluation of Carotid Stenosis by Angiography: Potential Bias toward Overestimated Measurements Introduced by Prior Interpretation of Doppler Sonograms AJNR Am. J. Neuroradiol., April 1, 2000; 21(4): 639 - 642. [Abstract] [Full Text]
|
|
|
|
|
|
M. M. Horrow, J. Stassi, A. Shurman, J. D. Brody, C. L. Kirby, and H. K. Rosenberg The Limitations of Carotid Sonography: Interpretive and Technology-Related Errors Am. J. Roentgenol., January 1, 2000; 174(1): 189 - 194. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. C. Arnold, K. B. Modaresi, N. Thomas, P. R. Taylor, and T. S. Padayachee Carotid Plaque Characterization by Duplex Scanning : Observer Error May Undermine Current Clinical Trials Stroke, January 1, 1999; 30(1): 61 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. J.M. Barnett, D. W. Taylor, M. Eliasziw, A. J. Fox, G. G. Ferguson, R. B. Haynes, R. N. Rankin, G. P. Clagett, V. C. Hachinski, D. L. Sackett, et al. Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis N. Engl. J. Med., November 12, 1998; 339(20): 1415 - 1425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. T. Smurawska, B. Bowyer, D. Rowed, R. Maggisano, P. Oh, and J. W. Norris Changing Practice and Costs of Carotid Endarterectomy in Toronto, Canada Stroke, October 1, 1998; 29(10): 2014 - 2017. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. N. Purcell and D. C. Brewster When Should Carotid Endarterectomy be Performed on the Basis of Carotid Noninvasive Examination Alone? Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1998; 9(2): 1 - 15. [Abstract] [PDF]
|
|
|
|
|
|
S. Chaturvedi, P. N. Policherla, and L. Femino Cerebral Angiography Practices at US Teaching Hospitals : Implications for Carotid Endarterectomy Stroke, October 1, 1997; 28(10): 1895 - 1897. [Abstract] [Full Text]
|
|
|
|
|
|
A. V. Alexandrov, D. Vital, D. S. Brodie, P. Hamilton, and J. C. Grotta Grading Carotid Stenosis With Ultrasound : An Interlaboratory Comparison Stroke, June 1, 1997; 28(6): 1208 - 1210. [Abstract] [Full Text]
|
|
|
|
|
|
J. H. Wong, J. M. Findlay, and M. E. Suarez-Almazor Regional Performance of Carotid Endarterectomy : Appropriateness, Outcomes, and Risk Factors for Complications Stroke, May 1, 1997; 28(5): 891 - 898. [Abstract] [Full Text]
|
|
|
|
|
|
F. Crawley, A. Clifton, H. Markus, and M. M. Brown Delayed Improvement in Carotid Artery Diameter After Carotid Angioplasty Stroke, March 1, 1997; 28(3): 574 - 579. [Abstract] [Full Text]
|
|
|
|
|
|
A. V. Alexandrov, D. S. Brodie, A. McLean, P. Hamilton, J. Murphy, and P. N. Burns Correlation of Peak Systolic Velocity and Angiographic Measurement of Carotid Stenosis Revisited Stroke, February 1, 1997; 28(2): 339 - 342. [Abstract] [Full Text]
|
|
|
|
|
|
R. M. Zwolak Carotid Endarterectomy Without Angiography: Are We Ready? Vascular and Endovascular Surgery, January 1, 1997; 31(1): 1 - 9. [PDF]
|
|
|
|
|
|
C. P. Derdeyn and W. J. Powers Cost-Effectiveness of Screening for Asymptomatic Carotid Atherosclerotic Disease Stroke, November 1, 1996; 27(11): 1944 - 1950. [Abstract] [Full Text]
|
|
|
|
|
|
G. Howard, W. H. Baker, L. E. Chambless, V. J. Howard, A. M. Jones, and J. F. Toole An Approach for the Use of Doppler Ultrasound as a Screening Tool for Hemodynamically Significant Stenosis (Despite Heterogeneity of Doppler Performance): A Multicenter Experience Stroke, November 1, 1996; 27(11): 1951 - 1957. [Abstract] [Full Text]
|
|
|
|
|
|
C. F. Bladin, A. C.F. Colchester, D. J. Hawkes, A. M. Seifalian, N. Iqbal, and C. R. Hardingham Morphological and Hemodynamic Assessments of Carotid Stenosis Using Quantitative Digital Subtraction Angiography Stroke, September 1, 1996; 27(9): 1672 - 1678. [Abstract] [Full Text]
|
|
|
|
|
|
E.B. Ringelstein Skepticism Toward Carotid Ultrasonography : A Virtue, an Attitude, or Fanaticism? Stroke, October 1, 1995; 26(10): 1743 - 1746. [Full Text]
|
|