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Carotid duplex scanning: patterns of referral and outcome
J M Perkins1, J Collin, J Walton
1Nuffield Department of Surgery, University of Oxford, John Radcliffe, U.K.
Objective:
Review of the results of carotid Duplex scanning.
Design:
Retrospective review of new referrals for carotid Duplex scanning to a regional vascular laboratory.
Materials:
1041 referrals made over an 18 month period.
Methods:
Referrals were reviewed for scan quality, diagnostic category and outcome of scanning.
Results:
The overall detection rate of ipsilateral stenoses > 70% and occlusions was 13.5%; the detection rate of surgically significant carotid lesions (70-99%) was only 8%. Analysis by diagnostic category revealed a significantly greater detection rate for carotid lesions > 70% in patients presenting with amaurosis fugax (24%) in comparison to those with TIAs (9.5%, p = 0.0005) or following a stroke (13%, p = 0.01). Patients referred with asymptomatic bruits or prior to cardiac surgery showed a positive scan rate of 30%. Sixty-seven carotid endarterectomies have resulted from scans performed in this period.
Conclusion:
The overall rate of detection for surgically relevant lesions is low, but in comparison to a similar audit conducted in 1992, the absolute number of carotid lesions > 70% has risen by 60%. An 8% detection rate for surgically relevant lesions may be valuable in projecting the need for carotid endarterectomy arising from a given number of Duplex scans.