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Intravenous DSA of extracranial carotid lesions: comparison with other techniques and specimens
Insights
Intravenous digital subtraction arteriography (DSA) accurately detects carotid artery stenosis, showing high sensitivity for guiding surgical management in ischemic cerebrovascular disease patients.
Area of Science:
- Neurology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Ischemic cerebrovascular disease poses a significant health risk.
- Accurate diagnosis of carotid artery stenosis is crucial for effective treatment.
- Non-invasive imaging modalities are essential for pre-surgical evaluation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of intravenous digital subtraction arteriography (IV DSA) in patients with suspected ischemic cerebrovascular disease.
- To compare the efficacy of IV DSA with conventional arteriography and sonographic imaging.
- To determine the sensitivity and specificity of IV DSA in identifying surgically significant carotid artery stenosis.
Main Methods:
- Intravenous digital subtraction arteriography (IV DSA) performed on 306 patients.
- Comparison of IV DSA findings with surgical results from 48 carotid endarterectomies.
- Analysis of IV DSA accuracy against conventional arteriography and high-resolution real-time sonography.
- Inclusion of supraorbital Doppler and oculopneumoplethysmography/Gee in sensitivity calculations.
Main Results:
- IV DSA concurred with surgical findings in 83.3% of cases, with a sensitivity of 93.7%.
- IV DSA demonstrated higher accuracy (83.7%) compared to sonography (67.5%) in evaluating surgical lesions.
- Conventional arteriography showed slightly higher accuracy than IV DSA in a small subset of lesions.
- Combined non-invasive tests achieved 93% sensitivity for detecting stenosis greater than 50%.
Conclusions:
- Intravenous DSA is a reliable imaging technique for assessing carotid artery stenosis in ischemic cerebrovascular disease.
- IV DSA offers a high sensitivity for detecting hemodynamically significant lesions, aiding clinical management decisions.
- Combining IV DSA with other non-invasive tests can further enhance diagnostic accuracy for cerebrovascular disease.
Abstract:
Intravenous digital subtraction arteriography (DSA) was performed in 306 patients with suspected ischemic cerebrovascular disease. Forty-eight carotid endarterectomies were performed in 43 of these patients. The percentage stenosis as determined on the intravenous DSA examination concurred (+/- 10%) with the surgical findings in 83.3%. There were 12.5% undercalls (false-negatives) and 4.3% overcalls (false-positives). Of the false-negative and false-positive examinations only three would have affected the clinical management of the patient, yielding an overall sensitivity of 93.7%. Nine surgical lesions had both intravenous DSA and conventional arteriography. Intravenous DSA was correct in six and arteriography in seven of these lesions. There were four surgically confirmed ulcerations. Two were evaluated by intravenous DSA alone. Two had intravenous DSA and arteriography. The latter showed both ulcers; the former, only one. Thirty-seven surgical lesions had both intravenous DSA and high-resolution real-time sonographic imaging. Sonography agreed in 67.5% and intravenous DSA in 83.7% of these lesions. When an abnormal supraorbital Doppler or an abnormal oculopneumoplethysmography/Gee examination is added to the sonographic examination, an overall sensitivity of 93% was obtained in detecting a surgical lesion (stenosis greater than 50%).
