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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Carotid stenosis in the real world--can Doppler ultrasound replace angiography in a district general hospital
C S Orgles1, S Chakraverty, T D Gopichandran
1Department of Radiology, Bradford Royal Infirmary, UK.
Insights
Carotid endarterectomy prevents stroke in patients with severe carotid artery stenosis. This study developed criteria to select surgical candidates using Doppler ultrasound alone, reducing the need for invasive angiography.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Carotid endarterectomy (CEA) is proven to prevent stroke in patients with severe internal carotid artery (ICA) stenosis (≥70%) and transient ischemic attacks (TIAs).
- Conventional confirmation involves invasive angiography, which carries risks.
- Non-invasive imaging like CT angiography and MR angiography are not universally accessible.
Purpose of the Study:
- To develop and validate criteria for identifying significant carotid artery stenosis using Doppler ultrasound alone.
- To enable patient selection for CEA based solely on Doppler ultrasound findings within a specific clinical setting.
- To reduce reliance on invasive confirmatory angiography.
Main Methods:
- Development of specific criteria for assessing carotid artery stenosis severity via Doppler ultrasound.
- Evaluation of the sensitivity, specificity, and accuracy of these Doppler-based criteria.
- Comparison of Doppler ultrasound selection with results from confirmatory angiography for a subset of patients.
Main Results:
- Established criteria allow for reliable identification of significant carotid artery stenosis using Doppler ultrasound.
- The developed criteria enable appropriate patient selection for CEA, minimizing the need for further invasive testing.
- Carotid arteriography was reserved for a minority of cases, indicating successful selection via Doppler ultrasound.
Conclusions:
- Doppler ultrasound, guided by developed criteria, can effectively identify patients with significant carotid artery stenosis eligible for CEA.
- This approach enhances patient selection for stroke prevention surgery while minimizing risks associated with invasive diagnostic procedures.
- The study supports the use of Doppler ultrasound as a primary tool for selecting patients for carotid endarterectomy.
Abstract:
Large trials have confirmed the benefit of carotid endarterectomy in the prevention of stroke in patients with transient ischaemic attacks and > or =70% stenosis of the ipsilateral internal carotid artery. Invasive confirmatory angiography carries some risk, but these patients can be identified by Doppler ultrasound. Non-invasive confirmatory testing with spiral computed tomographic angiography or magnetic resonance angiography is not easily available in many hospitals. In this study, criteria have been developed for use in this unit to identify significant carotid artery stenosis and enable selection for surgery after Doppler ultrasound alone, with known degrees of sensitivity, specificity and accuracy. Carotid arteriography is reserved for a minority of cases.
