From the Departments of Cardiology (J.Y., A.D., J.R.T.C.R.), Surgery
(M.R.H.M. v S.), Radiology (L.C. v D.), and Neurology (P.J.K.), Thoraxcenter
and Academic Hospital Dijkzigt, Erasmus University, Rotterdam, the
Netherlands, and Esaote Biomedica, SpA (M.K.), Florence, Italy.
Correspondence to Prof Dr Jos R.T.C. Roelandt, Room Bd 408, Thoraxcenter, 3015 GD Rotterdam, Netherlands. E-mail roelandt{at}card.azr.nl
Background and Purpose—It has
been proved that symptomatic patients with severe carotid
stenosis benefit from endarterectomy.
Currently used methods for quantitation of the severity of carotid
stenosis have limitations, and the impact of
endarterectomy on the operated region of carotid
artery remains unknown. The purpose of this study was to examine the
accuracy of a 3-D ultrasound system for quantitation of
stenotic lesions and to evaluate changes in regional vessel
volume and cross-sectional area after carotid endarterectomy.
Methods—We studied 14 patients with both carotid angiography and
3-D ultrasound. Of 13 patients who underwent surgery, 12 were
reexamined with 3-D ultrasound after surgery. The length and volume of
20 randomly selected plaques were measured from 3-D data sets. The
severity of stenosis was quantified by 3-D ultrasound using
both a diameter method and an area method on cross-sectional views at
the most stenotic site; the results were then compared with
those from carotid angiography. The segmental vessel volume and average
cross-sectional area of the operated artery both before and after
endarterectomy were measured from 3-D ultrasound
data.
Results—Good correlation was obtained between 3-D ultrasound and
carotid angiography in quantitative analysis of carotid
stenosis (SEE=12.4%, r=0.76, and mean
difference=7.0±12.3% with the diameter method; SEE=10.5%,
r=0.82, and mean difference=1.8±10.5% with the area
method by 3-D ultrasound). 3-D ultrasound had excellent reproducibility
and small intraobserver and interobserver variability in plaque length
and volume measurements. No significant changes in segmental vessel
volume and average cross-sectional area of the operated artery were
observed after surgery in patients with suture closure. However, a
significant increase in segmental vessel volume was obtained in
patients with polyfluorethylene patches applied to the surgical opening
of the artery.
Conclusions—3-D ultrasound can be used for both qualitative and
quantitative analysis of plaques in the carotid artery and to
detect and quantify significant carotid stenosis. Its
volumetric potential has important clinical implications in serial
follow-up studies for observing the progression or regression of
stenotic lesions and for evaluating the outcome of
interventional procedures such as endarterectomy or
stent placement.
© 1998 American Heart Association, Inc.
Original Contributions
Three-Dimensional Ultrasound Study of Carotid Arteries Before and After Endarterectomy
Analysis of Stenotic Lesions and Surgical Impact on the Vessel
Key Words: atherosclerosis • carotid arteries • carotid endarterectomy • carotid stenosis • ultrasonography
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