Abstract T P49: Diagnosis of Carotid Artery Near-Occlusion in Computed Tomography Angiography Compared to Catheter Angiography - Validation of Criteria and Implications for Clinical Practice
BACKGROUND/PURPOSE: Patients with near-occlusion (NO) of the internal carotid artery (ICA) are suggested to benefit from an exclusive therapeutic stratification. We intended to verify computertomography angiography (CTA) criteria for NO-detection by the catheter angiography (CA) reference and to investigate the impact of NO upon diagnosis of 70%-NASCET stenosis. We hypothesized, that selected CTA-criteria are non-inferior to detect NO compared to CA.
METHODS: Two independend observers analysed DICOM-images of 115 ICA stenoses obtained by multislice CTA and selective CA. Reference-NO’s were identified in CA by applying established criteria. Lumen measures and indizes previously applied to CTA , the minimal luminal diameter (MLD), the distal ipsilateral ICA (diICA) and the ratios between diICA and distal contralateral ICA (diICA : dcICA) and the diICA and ipsilateral external carotid artery (diICA : iECA) were validated against the CA-defined NO by receiver operator characteristic analysis (ROC).
RESULTS: The ROC-curves showed AUC for criteria MLD, dICA, dICA:dcICA and dICA:dICE of 0.867, 0.952, 0.919 and 0.957 at cutpoints of ≤1.1mm, ≤2.7mm, ≤0.64 and ≤0.90 for detecting CA defined NO. For the CTA-detection of NO a sensitivity and specificity of ≥93% was achieved with dICA and dICA:dcICA criteria. PPV values could be augmented by a combination of two criteria. Correlation of CTA with CA %-NASCET-degree of stenosis revealed a relevant amount of false negatively categorized stenosis <70% in part due to underestimation of NO stenoses by CTA.
CONCLUSIONS: CTA is an accurate modality for the detection of NO compared to CA. The detection of NO in CTA is important for correctly diagnosing severe stenosis.
Author Disclosures: R.R. Macharzina: None. E.S. Jochum: None. T. Rutkowski: None. B. Reuter: None. A. Rastan: None. W. Vach: None. F. Neumann: None. T. Zeller: None.
- © 2015 by American Heart Association, Inc.