[Comparative study of color Doppler echocardiography and arteriography in carotid disease]

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Neurology

Background:

• Duplex scanning accuracy has improved, reducing the need for invasive angiography in carotid lesion evaluation.
• Angiography carries significant morbidity, prompting a re-evaluation of its role in diagnosing carotid artery disease.

Purpose of the Study:

• To compare the diagnostic information provided by color duplex scanning and angiography for severe carotid lesions.
• To determine the impact of these imaging modalities on therapeutic decisions for patients with carotid artery disease.

Main Methods:

• A comparative analysis of 122 patients' preoperative color duplex scanning and angiographic results.
• Angiography was used as the reference standard for evaluating carotid artery stenosis and ulcerations.
• Pathologic examination of 94 surgically treated patients was used to assess ulceration detection accuracy.

Main Results:

• Color duplex scanning demonstrated 97% sensitivity and 57% specificity for detecting significant carotid artery stenosis.
• Both methods showed similar accuracy for screening ulcerations, detecting only two-thirds of those found on pathology.
• Angiography was more reliable for detecting carotid artery length variations, internal carotid thrombosis, and dissections in dysplastic arteries.

Conclusions:

• Selective indication of angiography is proposed for suspected proximal periaortic arterial lesions, complications in dysplastic arteries, and pre-thrombotic carotid lesions.
• Angiography is recommended to confirm significant stenosis in asymptomatic patients.
• Color duplex scanning is a valuable, less invasive tool, but angiography retains a crucial role for specific complex carotid artery pathologies.