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Related Experiment Videos

Colour-coded duplex sonography of preocclusive carotid stenoses

A Hetzel1, B Eckenweber, B Trummer

  • 1Department of Neurology, University Clinics Freiburg, Breisacherstr. 64, D-79106, Freiburg, Germany. hetzel@nz11.ukl.uni-freiburg.de

European Journal of Ultrasound : Official Journal of the European Federation of Societies for Ultrasound in Medicine and Biology
|February 11, 1999
PubMed
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Colour-coded duplex sonography (CCDS) accurately differentiates internal carotid artery (ICA) stenoses from occlusions. This non-invasive method is crucial for assessing atherosclerotic lesions before carotid endarterectomy, proving more reliable than angiography in some cases.

Area of Science:

  • Vascular Surgery
  • Diagnostic Imaging
  • Neurology

Background:

  • Accurate non-invasive quantification of internal carotid artery (ICA) atherosclerotic lesions is vital for determining the need for carotid endarterectomy.
  • Differentiating between preocclusive stenoses and occlusions of the ICA is a critical challenge in preoperative assessment.

Purpose of the Study:

  • To evaluate the accuracy of colour-coded duplex sonography (CCDS) in distinguishing between preocclusive stenoses (95-99%) and occlusions of the ICA.
  • To compare CCDS findings with ICA arteriography as the gold standard.

Main Methods:

  • A total of 401 consecutive patients underwent both CCDS and ICA arteriography.
  • Patients were categorized into groups based on stenosis severity: <90%, 90-94%, preocclusive (95-99%), and occlusions.

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  • Sensitivity, specificity, and predictive values were calculated using contingency tables.

    • Main Results:

    • CCDS demonstrated high sensitivity (88%) and specificity (99%) for identifying preocclusive stenoses (≥95%) and occlusions.
    • Predictive accuracy for differentiating severe carotid obstructions (90-94%, ≥95%, occluded) was high (97%, 96%, 93% respectively).
    • Intraoperative findings confirmed CCDS accuracy in cases where angiography was equivocal for preocclusive disease.

    Conclusions:

    • CCDS is a highly accurate tool for differentiating preocclusive ICA stenoses from occlusions.
    • Angiography may not always be the definitive gold standard for preocclusive carotid disease due to limitations in visualizing true area reduction.
    • Doppler ultrasound's hemodynamic estimation of stenosis may offer a more realistic assessment than angiographic measurements.