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Kwon YE, An CH, Choi KS, An SY. Comparison of carotid artery calcification between stroke and nonstroke patients using CT angiographic and panoramic images. Dentomaxillofac Radiol 2022; 51:20210500. [PMID: 35925038 PMCID: PMC9717401 DOI: 10.1259/dmfr.20210500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to analyze the characteristics of carotid artery calcification (CAC) in stroke and nonstroke patients using computed tomography angiographic (CTA) and panoramic images. METHODS This is a retrospective study on patients who acquired both CTA and panoramic images at the Neurology Department of Kyungpook National University Hospital, Daegu, South Korea, between 2011 and 2016. The patients were divided into stroke (n = 109) and nonstroke (n = 355) groups based on the final diagnosis. CAC was analyzed in each group based on its presence, shape, and severity using the [Formula: see text]2 test. The differences in age and sex between the two groups were examined using a two-sample t-test. A measure of intraobserver reliability was obtained using Cohen's κ index. RESULTS CAC was more frequently observed in the stroke group than in the nonstroke group using both CTA (stroke group, 100%; nonstroke group, 23.1%) and panoramic (stroke group, 83.5%; nonstroke group, 16.6%) images. Although scattered CAC shape and mild severity occupied the largest portion in both groups, vessel-outlined CAC was more common in nonstroke patients than in stroke patients. In age and sex analyses, only females patients in their 70 s showed significant differences in CAC shape between the stroke and nonstroke groups. CONCLUSIONS On both CTA and panoramic images, although CAC is found more frequently in the stroke group, vessel-outlined-shaped CAC in the nonstorke group shows significant differences compared to other shapes.
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Affiliation(s)
- Young-Eun Kwon
- Doctor of dental clinic, 7 Promise Dental Clinic, Daegu, Republic of Korea
| | - Chang-Hyeon An
- Department of Oral and Maxillofacial Radiology, School of Dentistry, IHBR, Kyungpook National University, Daegu, Republic of Korea
| | - Karp-Shik Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Seo-Young An
- Department of Oral and Maxillofacial Radiology, School of Dentistry, IHBR, Kyungpook National University, Daegu, Republic of Korea
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Manrique-Zegarra M, García-Pastor A, Castro-Reyes E, Guzmán-De-Villoria JA, Herrera Herrera I, Garrido Morro I, Del Valle Diéguez M, Fortea Gil F, González Cantero J, Saura Lorente J. CT angiography for diagnosis of carotid near-occlusion: a digital subtraction angiography validation study. Neuroradiology 2022; 64:1729-1735. [PMID: 35729332 DOI: 10.1007/s00234-022-02995-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Carotid near-occlusion (CNO) is a variant of severe stenosis where there is a distal luminal collapse of the internal carotid artery (ICA) beyond a tight stenosis. This study aimed to validate new visual extracranial diagnostic CT angiography (CTA) criteria, for the diagnosis of CNO. The new criteria include distal ICA diameter smaller than contralateral ICA and distal ICA diameter less than or equal to the ipsilateral external carotid artery (ECA). We also assessed the previously described CTA criteria: stenosis ≤ 1.3 mm, ipsilateral distal ICA ≤ 3.5 mm, ipsilateral distal ICA/contralateral distal ICA ratio ≤ 0.87, ipsilateral distal ICA/ipsilateral ECA ≤ 1.27. METHODS Fifty-eight patients with ICA stenosis (including the near-occlusion variant) or occlusion on digital subtraction angiography (DSA) were included. These patients had DSA and CTA studies completed within 30 days of each other. DSA was considered the reference test. Two neuroradiologists blinded to the DSA results assessed the CTA images and evaluated the new and previously published CNO diagnostic criteria. RESULTS Twenty-eight CNO were identified with DSA. The "distal ICA diameter less than or equal to the ipsilateral ECA" criterion had 79% sensitivity and 83% specificity with excellent interobserver agreement (kappa = 0.80), while three or more of the previously published criteria reached 82% sensitivity and 90% specificity, with a good interobserver agreement (kappa = 0.64). CONCLUSIONS CT angiography may be useful for CNO diagnosis. The new visual diagnostic criteria provide acceptable results of sensitivity and specificity with an excellent interobserver agreement. However, false-negative and positive results persist.
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Affiliation(s)
| | | | - Enrique Castro-Reyes
- Interventional Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Irene Garrido Morro
- Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Fernando Fortea Gil
- Interventional Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge González Cantero
- Interventional Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Saura Lorente
- Interventional Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Saba L, Antignani PL, Gupta A, Cau R, Paraskevas KI, Poredos P, Wasserman B, Kamel H, Avgerinos ED, Salgado R, Caobelli F, Aluigi L, Savastano L, Brown M, Hatsukami T, Hussein E, Suri JS, Mansilha A, Wintermark M, Staub D, Montequin JF, Rodriguez RTT, Balu N, Pitha J, Kooi ME, Lal BK, Spence JD, Lanzino G, Marcus HS, Mancini M, Chaturvedi S, Blinc A. International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches. Atherosclerosis 2022; 354:23-40. [DOI: 10.1016/j.atherosclerosis.2022.06.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
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Brain Functional Network in Chronic Asymptomatic Carotid Artery Stenosis and Occlusion: Changes and Compensation. Neural Plast 2020; 2020:9345602. [PMID: 33029129 PMCID: PMC7530486 DOI: 10.1155/2020/9345602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022] Open
Abstract
Asymptomatic carotid artery stenosis (CAS) and occlusion (CAO) disrupt cerebral hemodynamics. There are few studies on the brain network changes and compensation associated with the progression from chronic CAS to CAO. In the current study, our goal is to improve the understanding of the specific abnormalities and compensatory phenomena associated with the functional connection in patients with CAS and CAO. In this prospective study, 27 patients with CAO, 29 patients with CAS, and 15 healthy controls matched for age, sex, education, handedness, and risk factors underwent neuropsychological testing and resting-state functional magnetic resonance (rs-fMRI) imaging simultaneously; graph theoretical analysis of brain networks was performed to determine the relationship between changes in brain network connectivity and the progression from internal CAS to CAO. The global properties of the brain network assortativity (p = 0.002), hierarchy (p = 0.002), network efficiency (p = 0.011), and small-worldness (p = 0.009) were significantly more abnormal in the CAS group than in the control and CAO groups. In patients with CAS and CAO, the nodal efficiency of key nodes in multiple brain regions decreased, while the affected hemisphere lost many key functional connections. In this study, we found that patients with CAS showed grade reconstruction, invalid connections, and other phenomena that impaired the efficiency of information transmission in the brain network. A compensatory functional connection in the contralateral cerebral hemisphere of patients with CAS and CAO may be an important mechanism that maintains clinical asymptomatic performance. This study not only reveals the compensation mechanism of cerebral hemisphere ischemia but also validates previous explanations for brain function connectivity, which can help provide interventions in advance and reduce the impairment of higher brain functions. This trial is registered with Clinical Trial Registration-URL http://www.chictr.org.cn and Unique identifier ChiCTR1900023610.
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Chai S, Sheng Z, Xie W, Wang C, Liu S, Tang R, Cao C, Xin W, Guo Z, Chang B, Yang X, Zhu J, Xia S. Assessment of Apparent Internal Carotid Tandem Occlusion on High-Resolution Vessel Wall Imaging: Comparison with Digital Subtraction Angiography. AJNR Am J Neuroradiol 2020; 41:693-699. [PMID: 32115423 DOI: 10.3174/ajnr.a6452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/15/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Not all tandem occlusions diagnosed on traditional vascular imaging modalities, such as MRA, represent actual complete ICA occlusion. This study aimed to explore the utility of high-resolution vessel wall imaging in identifying true ICA tandem occlusions and screening patients for their suitability for endovascular recanalization. MATERIALS AND METHODS Patients with no signal in the ICA on MRA were retrospectively reviewed. Two neuroradiologists independently reviewed their high-resolution vessel wall images to assess whether there were true tandem occlusions and categorized all cases into intracranial ICA occlusion, extracranial ICA occlusion, tandem occlusion, or near-occlusion. DSA classified patient images into the same 4 categories, which were used as the comparison with high-resolution vessel wall imaging. The suitability for recanalization of occluded vessels was evaluated on high-resolution vessel wall imaging compared with DSA. RESULTS Forty-five patients with no ICA signal on MRA who had available high-resolution vessel wall imaging and DSA images were included. Among the 34 patients (34/45, 75.6%) with tandem occlusions on DSA, 18 cases also showed tandem occlusions on high-resolution vessel wall imaging. The remaining 16 patients, intracranial ICA, extracranial ICA occlusions and near-occlusions were found in 2, 6, and 8 patients, respectively, on the basis of high-resolution vessel wall imaging. A total of 20 cases (20/45, 44.4%) were considered suitable for recanalization on the basis of both DSA and high-resolution vessel wall imaging. Among the 25 patients deemed unsuitable for recanalization by DSA, 11 were deemed suitable for recanalization by high-resolution vessel wall imaging. CONCLUSIONS High-resolution vessel wall imaging could allow identification of true ICA tandem occlusion in patients with an absence of signal on MRA. Findings on high-resolution vessel wall imaging can be used to screen more suitable candidates for recanalization therapy.
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Affiliation(s)
- S Chai
- From the Department of Radiology (S.C., W. Xie, S.L., R.T., S.X.), First Central Clinical College, Tianjin Medical University, Tianjin, China.,Departments of Radiology and (S.C., W. Xie, S.L., R.T., S.X.), Tianjin First Central Hospital, Tianjin, China
| | - Z Sheng
- Neurosurgery (Z.S., C.W., B.C.), Tianjin First Central Hospital, Tianjin, China
| | - W Xie
- From the Department of Radiology (S.C., W. Xie, S.L., R.T., S.X.), First Central Clinical College, Tianjin Medical University, Tianjin, China.,Departments of Radiology and (S.C., W. Xie, S.L., R.T., S.X.), Tianjin First Central Hospital, Tianjin, China
| | - C Wang
- Neurosurgery (Z.S., C.W., B.C.), Tianjin First Central Hospital, Tianjin, China
| | - S Liu
- From the Department of Radiology (S.C., W. Xie, S.L., R.T., S.X.), First Central Clinical College, Tianjin Medical University, Tianjin, China.,Departments of Radiology and (S.C., W. Xie, S.L., R.T., S.X.), Tianjin First Central Hospital, Tianjin, China
| | - R Tang
- From the Department of Radiology (S.C., W. Xie, S.L., R.T., S.X.), First Central Clinical College, Tianjin Medical University, Tianjin, China.,Departments of Radiology and (S.C., W. Xie, S.L., R.T., S.X.), Tianjin First Central Hospital, Tianjin, China
| | - C Cao
- Department of Radiology (C.C.), Tianjin Huanhu Hospital, Tianjin, China
| | - W Xin
- Department of Neurosurgery (W. Xin, X.Y.), Tianjin Medical University General Hospital, Tianjin, China
| | - Z Guo
- Department of Neurosurgery (Z.G.), Tianjin TEDA Hospital, Tianjin, China
| | - B Chang
- Neurosurgery (Z.S., C.W., B.C.), Tianjin First Central Hospital, Tianjin, China
| | - X Yang
- Department of Neurosurgery (W. Xin, X.Y.), Tianjin Medical University General Hospital, Tianjin, China
| | - J Zhu
- MR Collaboration (J.Z.), Siemens Healthcare Ltd., Beijing, China
| | - S Xia
- From the Department of Radiology (S.C., W. Xie, S.L., R.T., S.X.), First Central Clinical College, Tianjin Medical University, Tianjin, China .,Departments of Radiology and (S.C., W. Xie, S.L., R.T., S.X.), Tianjin First Central Hospital, Tianjin, China
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Chrencik MT, Khan AA, Luther L, Anthony L, Yokemick J, Patel J, Sorkin JD, Sikdar S, Lal BK. Quantitative assessment of carotid plaque morphology (geometry and tissue composition) using computed tomography angiography. J Vasc Surg 2019; 70:858-868. [PMID: 30850296 DOI: 10.1016/j.jvs.2018.11.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Quantification of carotid plaque morphology (geometry and tissue composition) may help stratify risk for future stroke and assess plaque progression or regression in response to medical risk factor modification. We assessed the feasibility and reliability of morphologic measurements of carotid plaques using computed tomography angiography (CTA) and determined the minimum detectable change in plaque features by this approach. METHODS CTA images of both carotid arteries in 50 patients were analyzed by two observers using a semiautomatic image analysis program, yielding 93 observations per user (seven arteries were excluded because of prior stenting). One observer repeated the analyses 4 weeks later. Measurements included total plaque volume; percentage stenosis (by diameter and area); and tissue composition for calcium, lipid-rich necrotic core (LRNC), and intraplaque hemorrhage (IPH). Reliability of measurements was assessed by intraclass and interclass correlation and Bland-Altman plots. Dice similarity coefficient (DSC) and modified Hausdorff distance (MHD) assessed reliability of geometric shape measurements. We additionally computed the minimum amount of change in these features detectable by our approach. RESULTS The cohort was 51% male (mean age, 70.1 years), and 56% had a prior stroke. The mean (± standard deviation) plaque volume was 837.3 ± 431.3 mm3, stenosis diameter was 44.5% ± 25.6%, and stenosis area was 58.1% ± 29.0%. These measurements showed high reliability. Intraclass correlation coefficients for plaque volume, percentage stenosis by diameter, and percentage stenosis by area were 0.96, 0.87, and 0.83, respectively; interclass correlation coefficients were 0.88, 0.84, and 0.78. Intraclass correlations for tissue composition were 0.99, 0.96, and 0.86 (calcium, LRNC, and IPH, respectively), and interclass correlations were 0.99, 0.92, and 0.92. Shape measurements showed high intraobserver (DSC, 0.95 ± 0.04; MHD, 0.16 ± 0.10 mm) and interobserver (DSC, 0.94 ± 0.05; MHD, 0.19 ± 0.12 mm) luminal agreement. This approach can detect a change of at least 3.9% in total plaque volume, 1.2 mm3 in calcium, 4.3 mm3 in LRNC, and 8.6 mm3 in IPH with the same observer repeating measurements and 9.9% in plaque volume, 1.9 mm3 in calcium, 7.9 mm3 in LRNC, and 6.8 mm3 in IPH for two different observers. CONCLUSIONS Carotid plaque geometry (total volume, diameter stenosis, and area stenosis) and tissue composition (calcium, LRNC, and IPH) are measured reliably from clinical CTA images using a semiautomatic image analysis program. The minimum change in plaque volume detectable is ∼4% if the same observer makes both measurements and ∼10% for different observers. Small changes in plaque composition can also be detected reliably. This approach can facilitate longitudinal studies for identifying high-risk plaque features and for quantifying plaque progression or regression after treatment.
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Affiliation(s)
- Matthew T Chrencik
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Amir A Khan
- Department of Bioengineering, George Mason University, Fairfax, Va
| | - Lauren Luther
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Laila Anthony
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - John Yokemick
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md
| | - Jigar Patel
- Imaging Service, VA Maryland Health Care System, Baltimore, Md
| | - John D Sorkin
- Baltimore VA Medical Center Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, Md; Claude D. Pepper Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, Md
| | | | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, Md; Vascular Service, Veterans Affairs Medical Center, Baltimore, Md.
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Lev MH. Cervical Internal Carotid Artery Occlusion versus Pseudo-Occlusion: Can CT Angiography Help Distinguish These in the Acute Stroke Setting? Radiology 2018; 286:1095-1096. [DOI: 10.1148/radiol.2018172527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael H. Lev
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2622
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Diouf A, Fahed R, Gaha M, Chagnon M, Khoury N, Kotowski M, Guilbert F, Landry D, Raymond J, Roy D, Weill A. Cervical Internal Carotid Occlusion versus Pseudo-occlusion at CT Angiography in the Context of Acute Stroke: An Accuracy, Interobserver, and Intraobserver Agreement Study. Radiology 2018; 286:1008-1015. [DOI: 10.1148/radiol.2017170681] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ange Diouf
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - Robert Fahed
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - Mehdi Gaha
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - Miguel Chagnon
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - Naïm Khoury
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - Marc Kotowski
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - François Guilbert
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - David Landry
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - Jean Raymond
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - Daniel Roy
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
| | - Alain Weill
- From the Department of Radiology, Centre Hospitalier de l'Université de Montréal-CHUM, Notre-Dame Hospital, 1560 Sherbrooke East, Pavilion Simard, Suite Z12909, Montreal, QC, Canada H2L 4M1
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Rocha M, Delfyett WT, Agarwal V, Aghaebrahim A, Jadhav A, Jovin TG. Diagnostic accuracy of emergency CT angiography for presumed tandem internal carotid artery occlusion before acute endovascular therapy. J Neurointerv Surg 2017; 10:653-656. [PMID: 29101306 DOI: 10.1136/neurintsurg-2017-013169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Extracranial internal carotid artery (ICA) occlusion can be overestimated on emergent single phase CT angiography (CTA) of stroke patients with isolated intracranial ICA occlusion. We aimed to measure the ability of identifying the extracranial site of presumed tandem ICA occlusions on pre-procedural CTA relative to catheter angiography during acute endovascular stroke therapy. METHODS Retrospective study of patients with intracranial ICA occlusion, with or without extracranial ICA occlusion, who underwent single phase CTA before acute endovascular treatment. Two neuroradiologists reviewed CTA images for the presence or absence of extracranial ICA occlusion, blinded to the catheter angiography results. The sensitivity, specificity, and predictive values of presumed extracranial ICA occlusions on CTA were calculated in reference to catheter angiography. RESULTS 91 stroke patients with acute intracranial ICA occlusion met the inclusion criteria for the study. 24% of patients (22/91) had tandem ICA occlusion confirmed on catheter angiography. Single phase CTA had a sensitivity of 95.5% (95% CI 77.2 to 99.9%) and a specificity of 69.6% (95% CI 57.3 to 80.1%) for concomitant extracranial ICA occlusion (false positive rate 30.4%). The positive and negative predictive values of single phase CTA for extracranial ICA occlusion in the presence of a distal ICA occlusion were 50% (95% CI 34.2 to 65.8%) and 98% (95% CI 89.1 to 100%), respectively. CONCLUSIONS Emergency single phase CTA is highly sensitive but has reduced specificity to identify extracranial ICA occlusion in patients with intracranial ICA occlusion, which may confound planning for acute endovascular stroke therapy and cause over exclusion of patients with isolated ICA terminus occlusion from clinical trials.
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Affiliation(s)
- Marcelo Rocha
- Neurology Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - William T Delfyett
- Radiology Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vikas Agarwal
- Radiology Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Ashutosh Jadhav
- Neurology Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tudor G Jovin
- Neurology Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Maddula M, Sprigg N, Bath PM, Munshi S. Cerebral misery perfusion due to carotid occlusive disease. Stroke Vasc Neurol 2017; 2:88-93. [PMID: 28959496 PMCID: PMC5600014 DOI: 10.1136/svn-2017-000067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 11/06/2022] Open
Abstract
Purpose Cerebral misery perfusion (CMP) is a condition where cerebral autoregulatory capacity is exhausted, and cerebral blood supply in insufficient to meet metabolic demand. We present an educational review of this important condition, which has a range of clinical manifestations. Method A non-systematic review of published literature was undertaken on CMP and major cerebral artery occlusive disease, using Pubmed and Sciencedirect. Findings Patients with CMP may present with strokes in watershed territories, collapses and transient ischaemic attacks or episodic movements associated with an orthostatic component. While positron emission tomography is the gold standard investigation for misery perfusion, advanced MRI is being increasingly used as an alternative investigation modality. The presence of CMP increases the risk of strokes. In addition to the devastating effect of stroke, there is accumulating evidence of impaired cognition and quality of life with carotid occlusive disease (COD) and misery perfusion. The evidence for revascularisation in the setting of complete carotid occlusion is weak. Medical management constitutes careful blood pressure management while addressing other vascular risk factors. Discussion The evidence for the management of patients with COD and CMP is discussed, together with recommendations based on our local experience. In this review, we focus on misery perfusion due to COD. Conclusion Patients with CMP and COD may present with a wide-ranging clinical phenotype and therefore to many specialties. Early identification of patients with misery perfusion may allow appropriate management and focus on strategies to maintain or improve cerebral blood flow, while avoiding potentially harmful treatment.
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Affiliation(s)
- Mohana Maddula
- Acute Stroke Unit, Tauranga Hospital, Tauranga, New Zealand
| | - Nikola Sprigg
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Philip M Bath
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Sunil Munshi
- Department of Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Bates ER, Babb JD, Casey DE, Cates CU, Duckwiler GR, Feldman TE, Gray WA, Ouriel K, Peterson ED, Rosenfield K, Rundback JH, Safian RD, Sloan MA, White CJ. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting. Vasc Med 2016; 12:35-83. [PMID: 17451093 DOI: 10.1177/1358863x06076103] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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Johansson E, Fox AJ. Carotid Near-Occlusion: A Comprehensive Review, Part 2--Prognosis and Treatment, Pathophysiology, Confusions, and Areas for Improvement. AJNR Am J Neuroradiol 2015; 37:200-4. [PMID: 26338908 DOI: 10.3174/ajnr.a4429] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In Part 1 of this review, the definition, terminology, and diagnosis of carotid near-occlusion were presented. Carotid near-occlusions (all types) showed a lower risk of stroke than other severe stenoses. However, emerging evidence suggests that the near-occlusion prognosis with full collapse (higher risk) differs from that without full collapse (lower risk). This systematic review presents what is known about carotid near-occlusion. In this second part, the foci are prognosis and treatment, pathophysiology, the current confusion about near-occlusion, and areas in need of future improvement.
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Affiliation(s)
- E Johansson
- From the Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Umeå, Sweden
| | - A J Fox
- Department of Neuroradiology (A.J.F.), Sunnybrook Heath Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Johansson E, Fox AJ. Carotid Near-Occlusion: A Comprehensive Review, Part 1--Definition, Terminology, and Diagnosis. AJNR Am J Neuroradiol 2015; 37:2-10. [PMID: 26316571 DOI: 10.3174/ajnr.a4432] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/08/2015] [Indexed: 12/28/2022]
Abstract
Carotid near-occlusion is distal ICA luminal collapse beyond a tight stenosis, where the distal lumen should not be used for calculating percentage stenosis. Near-occlusion with full ICA collapse is well-known, with a threadlike lumen. However, near-occlusion without collapse is often subtle and can be overlooked as a usual severe stenosis. More than 10 different terms have been used to describe near-occlusion, sometimes causing confusion. This systematic review presents what is known about carotid near-occlusion. In this first part, the foci are definition, terminology, and diagnosis.
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Affiliation(s)
- E Johansson
- From the Department of Pharmacology and Clinical Neuroscience (E.J.), Umeå University, Umeå, Sweden
| | - A J Fox
- Department of Neuroradiology (A.J.F.), Sunnybrook Heath Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Johansson E, Öhman K, Wester P. Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med 2015; 277:615-23. [PMID: 25297638 DOI: 10.1111/joim.12318] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of early stroke recurrence amongst patients with symptomatic carotid near-occlusion with and without full collapse is unknown. Therefore, the aim of this study was to analyse the 90-day risk of recurrent ipsilateral ischaemic stroke in patients with symptomatic carotid near-occlusion both with and without full collapse. METHODS This study was a secondary analysis of the Additional Neurological SYmptoms before Surgery of the Carotid Arteries: a Prospective study (ANSYSCAP). We prospectively analysed 230 consecutive patients with symptomatic 50-99% carotid stenosis or near-occlusion. Based on the combination of several imaging modalities, 205 (89%) patients were classified as having 50-99% carotid stenosis, and 10 (4%) and 15 (7%) as having near-occlusion with and without full collapse, respectively. The 90-day risk of recurrent ipsilateral ischaemic stroke was compared between these three groups. Only events that occurred before carotid endarterectomy were analysed. RESULTS The 90-day risk of recurrent stroke was 18% [95% confidence interval (CI) 12-25%; n = 29] for patients with 50-99% carotid stenosis, 0% for patients with near-occlusion without full collapse and 43% (95% CI 25-89%; n = 4) for patients with near-occlusion with full collapse (P = 0.035, log-rank test). The increased risk of recurrent ipsilateral ischaemic stroke for patients with symptomatic near-occlusion with full collapse remained significant after multivariable adjustment for age, sex and type of presenting event. CONCLUSIONS Patients with symptomatic carotid near-occlusion with full collapse might have a very high risk of stroke recurrence. Carotid endarterectomy could be considered for these patients.
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Affiliation(s)
- E Johansson
- Department of Pharmacology and Clinical Neuroscience and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Abstract
Stroke is the third leading cause of death in developed nations. Up to 88% of strokes are ischemic in nature. Extracranial carotid artery atherosclerotic disease is the third leading cause of ischemic stroke in the general population and the second most common nontraumatic cause among adults younger than 45 years. This article provides comprehensive, evidence-based recommendations for the management of extracranial atherosclerotic disease, including imaging for screening and diagnosis, medical management, and interventional management.
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Affiliation(s)
- Yinn Cher Ooi
- Department of Neurosurgery, University of California, Los Angeles
| | - Nestor R. Gonzalez
- Department of Neurosurgery and Radiology, University of California, Los Angeles, 100 UCLA Med Plaza Suite# 219, Los Angeles, CA 90095, +1(310)825-5154
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Ventura CAP, Silva ESD, Cerri GG, Leão PP, Tachibana A, Chammas MC. Can contrast-enhanced ultrasound with second-generation contrast agents replace computed tomography angiography for distinguishing between occlusion and pseudo-occlusion of the internal carotid artery? Clinics (Sao Paulo) 2015; 70:1-6. [PMID: 25672421 PMCID: PMC4311125 DOI: 10.6061/clinics/2015(01)01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/13/2014] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the effectiveness of contrast-enhanced ultrasound with a second-generation contrast agent in distinguishing between occlusion and pseudo-occlusion of the cervical internal carotid artery, comparing it with that of conventional Doppler ultrasound and the gold standard, computed tomography angiography. METHOD Between June 2006 and June 2012, we screened 72 symptomatic vascular surgery outpatients at a public hospital. Among those patients, 78 cervical internal carotid arteries were previously classified as occluded by Doppler ultrasound (without contrast). The patients were examined again with Doppler ultrasound, as well as with contrast-enhanced ultrasound and computed tomography angiography. The diagnosis was based on the presence or absence of flow. RESULTS Among the 78 cervical internal carotid arteries identified as occluded by Doppler ultrasound, occlusion was confirmed by computed tomography angiography in only 57 (73.1%), compared with 59 (77.5%) for which occlusion was confirmed by contrast-enhanced ultrasound (p>0.5 vs. computed tomography angiography). Comparing contrast-enhanced ultrasound with Doppler ultrasound, we found that the proportion of cervical internal carotid arteries classified as occluded was 24.4% higher when the latter was used (p<0.001). CONCLUSIONS We conclude that, in making the differential diagnosis between occlusion and pseudo-occlusion of the cervical internal carotid artery, contrast-enhanced ultrasound with a second-generation contrast agent is significantly more effective than conventional Doppler ultrasound and is equally as effective as the gold standard (computed tomography angiography). Our findings suggest that contrast-enhanced ultrasound could replace computed tomography angiography in this regard.
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Affiliation(s)
- Carlos Augusto Pinto Ventura
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Erasmo Simão da Silva
- Department of Surgery, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Giovanni Guido Cerri
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Puech Leão
- Department of Vascular Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriano Tachibana
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Cristina Chammas
- Department of Ultrasound, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Gasparian GG, Sanossian N, Shiroishi MS, Liebeskind DS. Imaging of occlusive thrombi in acute ischemic stroke. Int J Stroke 2014; 10:298-305. [PMID: 25545291 DOI: 10.1111/ijs.12435] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 11/14/2014] [Indexed: 11/29/2022]
Abstract
Thrombi, or clots, often occlude proximal segments of the cerebral arterial circulation in acute ischemic stroke. Thromboembolic occlusion or thrombi superimposed on atherosclerotic plaque are the principal focus of acute stroke therapies such as thrombolysis or thrombectomy. We review the imaging characteristics of thrombi on multimodal computed tomography and magnetic resonance imaging, angiography, and ultrasonography, summarizing recent studies that facilitate therapeutic decision-making from these noninvasive studies. Information about the location, size, and imaging characteristics can be ascertained using these techniques. Imaging findings in relation to occlusive thrombus have been correlated with clot pathology, response to therapeutic interventions, and clinical outcome. Diagnostic evaluation of occlusive thrombi on noninvasive studies now constitutes an integral component of acute stroke management.
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Affiliation(s)
- Gregory G Gasparian
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Luitse MJA, Velthuis BK, Dauwan M, Dankbaar JW, Biessels GJ, Kappelle LJ. Residual high-grade stenosis after recanalization of extracranial carotid occlusion in acute ischemic stroke. Stroke 2014; 46:12-5. [PMID: 25492908 DOI: 10.1161/strokeaha.114.007169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Residual stenosis after recanalization of an acute symptomatic extracranial occlusion of the internal carotid artery (ICA) might be an indication for carotid endarterectomy. We evaluated the proportion of residual high-grade stenosis (≥70%, near occlusions not included) on follow-up imaging in a consecutive series of patients with an acute symptomatic occlusion of the extracranial ICA. METHODS We included patients participating in the Dutch Acute Stroke Study (DUST), who had an acute symptomatic occlusion of the extracranial ICA that was diagnosed on computed tomographic angiography within 9 hours after onset of neurological symptoms. Follow-up imaging of the carotid artery had to be available within 7 days after admission. RESULTS Of the 1021 patients participating in DUST between May 2009 and May 2013, an acute symptomatic occlusion of the extracranial ICA was found in 126 (12.3%) patients. Follow-up imaging was available in 86 (68.3%) of these patients. At follow-up, a residual stenosis of <30% was found in 15 (17.4%; 95% confidence interval, 10.8-26.9) patients, a 30% to 49% stenosis in 3 (3.5%; 95% confidence interval, 0.8-10.2) patients, a 50% to 69% stenosis in 2 (2.3%; 95% confidence interval, 0.1-8.6) patients, and a ≥70% stenosis in 14 (16.3%; 95% confidence interval, 9.8-25.6) patients. A near or persistent occlusion was present in the remaining 52 (60.5%) patients. CONCLUSIONS A residual high-grade stenosis of the extracranial ICA occurs in 1 of 6 patients with a symptomatic occlusion in the acute stage of cerebral ischemia. Because this may have implications for secondary prevention, we recommend follow-up imaging in these patients within a week after the event. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00880113.
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Affiliation(s)
- Merel J A Luitse
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Birgitta K Velthuis
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Meenakshi Dauwan
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Jan Biessels
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands
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El Raouf SA, El Maati AAA, Chalabi N. Agreement between multi-detector-row CT angiography and US-ECD in quantification of carotid artery stenosis and plaque characterization. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Marquering HA, Nederkoorn PJ, Beenen LF, Nijeholt GJLÀ, van den Berg R, Roos YB, Majoie CB. Carotid pseudo-occlusion on CTA in patients with acute ischemic stroke: A concerning observation. Clin Neurol Neurosurg 2013; 115:1591-4. [DOI: 10.1016/j.clineuro.2013.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/09/2013] [Accepted: 02/03/2013] [Indexed: 11/29/2022]
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Distinguishing Critical Stenosis from Occlusion of the Internal Carotid Artery by Carotid Duplex in a Patient with Acute Ischemic Stroke. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sun Z. Multislice computed tomography angiography in the diagnosis of cardiovascular disease: 3D visualizations. Front Med 2011; 5:254-70. [DOI: 10.1007/s11684-011-0153-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Stroke 2011; 42:e420-63. [DOI: 10.1161/str.0b013e3182112d08] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Thomas G. Brott
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Jonathan L. Halperin
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Suhny Abbara
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - J. Michael Bacharach
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - John D. Barr
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Christopher U. Cates
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Mark A. Creager
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Susan B. Fowler
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Gary Friday
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - E. Bruce McIff
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Peter D. Panagos
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Thomas S. Riles
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Robert H. Rosenwasser
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Allen J. Taylor
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Circulation 2011; 124:489-532. [DOI: 10.1161/cir.0b013e31820d8d78] [Citation(s) in RCA: 406] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas G. Brott
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Jonathan L. Halperin
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Suhny Abbara
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - J. Michael Bacharach
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - John D. Barr
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Christopher U. Cates
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Mark A. Creager
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Susan B. Fowler
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Gary Friday
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - E. Bruce McIff
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | | | - Peter D. Panagos
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Thomas S. Riles
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Robert H. Rosenwasser
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
| | - Allen J. Taylor
- ASA Representative. ACCF/AHA Representative and ACCF/AHA Task Force on Performance Measures Liaison. SCCT Representative. SVM Representative. ACR, ASNR, and SNIS Representative. SCAI Representative. ACCF/AHA Task Force on Practice Guidelines Liaison. AANN Representative. AAN Representative. SIR Representative. ACEP Representative. SVS Representative. AANS and CNS Representative. SAIP Representative. Former Task Force member during this writing effort
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. Vasc Med 2011; 16:35-77. [DOI: 10.1177/1358863x11399328] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Saba L, Sanfilippo R, Montisci R, Atzeni M, Ribuffo D, Mallarini G. Vulnerable plaque: Detection of agreement between multi-detector-row CT angiography and US-ECD. Eur J Radiol 2011; 77:509-15. [DOI: 10.1016/j.ejrad.2009.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 08/07/2009] [Accepted: 09/03/2009] [Indexed: 11/28/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ, Jacobs AK, Smith SC, Anderson JL, Adams CD, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ohman EM, Page RL, Riegel B, Stevenson WG, Tarkington LG, Yancy CW. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary. Catheter Cardiovasc Interv 2011; 81:E76-123. [DOI: 10.1002/ccd.22983] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary. J Am Coll Cardiol 2011; 57:1002-44. [DOI: 10.1016/j.jacc.2010.11.005] [Citation(s) in RCA: 262] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. J Am Coll Cardiol 2011; 57:e16-94. [PMID: 21288679 DOI: 10.1016/j.jacc.2010.11.006] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Stroke 2011; 42:e464-540. [PMID: 21282493 DOI: 10.1161/str.0b013e3182112cc2] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 2011; 124:e54-130. [PMID: 21282504 DOI: 10.1161/cir.0b013e31820d8c98] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Delgado Almandoz JE, Romero JM, Pomerantz SR, Lev MH. Computed Tomography Angiography of the Carotid and Cerebral Circulation. Radiol Clin North Am 2010; 48:265-81, vii-viii. [DOI: 10.1016/j.rcl.2010.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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CT angiography covering both cervical and cerebral arteries using high iodine concentration contrast material with dose reduction on a 16 multidetector-row system. Neuroradiology 2009; 52:291-5. [DOI: 10.1007/s00234-009-0611-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 10/05/2009] [Indexed: 10/20/2022]
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Grading of carotid artery stenosis with multidetector-row CT angiography: visual estimation or caliper measurements? Eur Radiol 2009; 19:2809-18. [PMID: 19618190 PMCID: PMC2778777 DOI: 10.1007/s00330-009-1508-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 05/27/2009] [Accepted: 06/04/2009] [Indexed: 11/30/2022]
Abstract
To assess the optimal method for grading carotid artery stenosis with computed tomographic angiography (CTA), we compared visual estimation to caliper measurements, and determined inter-observer variability and agreement relative to digital subtraction angiography (DSA). We included 46 patients with symptomatic carotid stenosis for whom CTA and DSA of 55 carotids was available. Stenosis quantification by CTA using visual estimation (CTAVE) (method 1) was compared with caliper measurements using subjectively optimized wide window settings (method 2) or predefined contrast-dependent narrow window settings (method 3). Measurements were independently performed by two radiologists and two residents. To determine accuracy and inter-observer variability, we calculated linear weighted kappa, performed a Bland-Altman analysis and calculated mean difference (bias) and standard deviation of differences (SDD). For inter-observer variability, kappa analysis was “very good” (0.85) for expert observers using CTAVE compared with “good” (0.61) for experts using DSA. Compared with DSA, method 1 led to overestimation (bias 5.8–8.0%, SDD 10.6–14.4), method 3 led to underestimation (bias −6.3 to −3.0%, SDD 13.0–18.1). Measurement variability between DSA and visual estimation on CTA (SDD 11.5) is close to the inter-observer variability of repeated measurements on DSA that we found in this study (SDD 11.6). For CTA of carotids, stenosis grading based on visual estimation provides better agreement to grading by DSA compared with stenosis grading based on caliper measurements.
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Saba L, Montisci R, Sanfilippo R, Mallarini G. Multidetector row CT of the brain and carotid artery: a correlative analysis. Clin Radiol 2009; 64:767-78. [PMID: 19589415 DOI: 10.1016/j.crad.2009.03.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/16/2009] [Accepted: 03/19/2009] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the association between types of carotid plaque, the presence of prior ischaemic events detectable with CT, and patient's symptoms. MATERIALS AND METHODS Between January 2004 and May 2006, 112 patients were evaluated using multidetector row computed tomography angiography (MDCTA) of the carotid arteries and computed tomography (CT) of the brain. Carotid arteries were categorized by evaluating the degree of stenosis according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, the type of plaque, and the presence of plaque ulceration. The brain was assessed via CT for the presence, type, and position of lesions. Chi-square tests, Student's t test, and simple logistic regression analysis were performed and the Cohen kappa test was applied for interobserver variability measurement. RESULTS The Chi-square test indicated a statistically significant association between the presence of fatty plaques (p=0.005) and CT-detectable lesions in the brain (p=0.004). Moreover, the number of patients with CT-detectable brain lesions was greater in patients with >70% stenosis than in those with <70% stenosis (p=0.007). Logistic regression confirmed the association between fatty plaque and symptoms (p=0.001), between >70% stenosis and symptoms (p=0.041), and an inverse association between calcified plaque and symptoms (p=0.009). CONCLUSION MDCTA allows adequate evaluation of the type of plaque. The results of the present study indicate that there is an association between cerebral lesions, symptoms, and fatty plaque in the carotid artery. The degree of stenosis also correlated with cerebral lesions and symptoms. According to the obtained data, the type of carotid plaque should be included among primary parameters in the classification of patients' risk class.
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Affiliation(s)
- L Saba
- Department of Imaging Science, Policlinico Universitario, s.s. 554 Monserrato (Cagliari) 09045, Italy.
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36
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Ajduk M, Pavić L, Bulimbasić S, Sarlija M, Pavić P, Patrlj L, Brkljacić B. Multidetector-row computed tomography in evaluation of atherosclerotic carotid plaques complicated with intraplaque hemorrhage. Ann Vasc Surg 2008; 23:186-93. [PMID: 18657388 DOI: 10.1016/j.avsg.2008.05.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 03/03/2008] [Accepted: 05/08/2008] [Indexed: 11/30/2022]
Abstract
Our aim was to determine the sensitivity and specificity of multidetector-row computed tomography (CT) in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage. We examined carotid plaques from 31 patients operated for carotid artery stenosis. Results of preoperative multidetector-row CT analysis of carotid plaques were compared with results of histological analysis of the same plaque areas. Carotid endarterectomy was performed within 1 week of multidetector-row CT. American Heart Association classification of atherosclerotic plaques was applied for histological classification. Median tissue density of carotid plaques complicated with intraplaque hemorrhage was 22 Hounsfield units (HU). Median tissue density of noncalcified segments of uncomplicated plaques was 59 HU (p=0.0062). The highest tissue density observed for complicated plaques was 31 HU. Multidetector-row CT detected plaques complicated with hemorrhage with sensitivity of 100% and specificity of 64.7%, with tissue density of 31 HU as a threshold value. Multidetector-row CT showed a high level of sensitivity and a moderate level of specificity in detecting atherosclerotic carotid plaques complicated with hemorrhage.
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Affiliation(s)
- Marko Ajduk
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia.
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Lin PH, Bechara C, Kougias P, Huynh TT, LeMaire SA, Coselli JS. Assessment of aortic pathology and peripheral arterial disease using multidetector computed tomographic angiography. Vasc Endovascular Surg 2008; 42:583-98. [PMID: 18621886 DOI: 10.1177/1538574408320029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of multidetector computed tomography represents a remarkable diagnostic advancement because this imaging modality has been widely used in the evaluation of the cardiovascular system. With scanner-adjusted image acquisition and contrast medium administration, multidetector computed tomographic angiography provides a cost-effective and accurate imaging assessment in patients with aortic pathologies or peripheral arterial occlusive disease. Multidetector computed tomographic angiography is associated with several advantages, including high image spatial resolution and rapid imaging acquisition speed. This diagnostic methodology allows accurate detection of a variety of intravascular lesions in the carotid artery, thoracic and abdominal aorta, renal arteries, and peripheral arterial systems. This article provides an overview of multidetector computed tomographic angiography in the assessment of arterial disease and reviews current literature about this diagnostic technology in the evaluation of aortic and peripheral arterial pathologies.
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Affiliation(s)
- Peter H Lin
- Division of Vascular Surgery and Endovascular Therapy, Houston, Texas, USA.
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Hammond CJ, McPherson SJ, Patel JV, Gough MJ. Assessment of apparent internal carotid occlusion on ultrasound: prospective comparison of contrast-enhanced ultrasound, magnetic resonance angiography and digital subtraction angiography. Eur J Vasc Endovasc Surg 2008; 35:405-12. [PMID: 18262445 DOI: 10.1016/j.ejvs.2007.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Accepted: 12/16/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Modern conventional ultrasound is sensitive to slow flow, but may misclassify some tight stenoses as occlusion. Symptomatic patients with tight proximal internal carotid artery stenoses may benefit from carotid endarterectomy but those with occlusion or long-segment disease do not. DESIGN A prospective study of the diagnostic accuracy of contrast-enhanced ultrasound (CE-US), 2D time-of-flight magnetic resonance angiography (2D-TOF MRA) and contrast-enhanced magnetic resonance angiography (CE-MRA) against a reference standard of digital subtraction angiography (DSA) in patients with apparent carotid occlusion on conventional ultrasound. MATERIALS AND METHODS Thirty-one patients with apparent carotid occlusion on conventional ultrasound and with recent ispilateral hemispheric transient ischaemeic attacks (TIAs) were studied. The primary endpoint was confirmation of occlusion with a secondary endpoint of identification of a surgically correctible lesion. RESULTS The sensitivity and specificity of CE-US, 2D-TOF MRA and CE-MRA for patency were 1 & 1, 0.33 & 1 and 0.6 & 1 respectively and for the detection of a surgically correctible lesion were 1 & 0.96, 0.67 & 1 and 1 and 0.96 respectively. CE-US was difficult to interpret, precluding confident diagnosis in 5 cases. CONCLUSIONS 2D-TOF MRA had poor sensitivity for patency and cannot be recommended as a second-line investigation to assess vessels apparently occluded on conventional ultrasound. Confident diagnosis on CE-US and CE-MRA accurately identified occlusion. If occlusion is confirmed by either of these modalities, no further imaging is required. The relative advantages of CE-US or CE-MRA in this situation are uncertain.
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Affiliation(s)
- C J Hammond
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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Brown DL, Hoffman SN, Jacobs TL, Gruis KL, Johnson SL, Chernew ME. CT angiography is cost-effective for confirmation of internal carotid artery occlusions. J Neuroimaging 2008; 18:355-9. [PMID: 18321251 DOI: 10.1111/j.1552-6569.2007.00216.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE While sensitive to internal carotid artery (ICA) occlusion, carotid ultrasound can produce false-positive results. CT angiography (CTA) has a high specificity for ICA occlusion and is safer and cheaper than catheter angiography, although less accurate. We determined the cost-effectiveness of CTA versus catheter angiography for confirming an ICA occlusion first suggested by carotid ultrasound. METHODS A Markov decision-analytic model was constructed to estimate the cost-effectiveness of CTA compared with catheter angiography in a hypothetical cohort of symptomatic patients with a screening examination consistent with an ICA occlusion. Costs in 2004 dollars were estimated from Medicare reimbursement. Effectiveness was measured in quality-adjusted life years. RESULTS The 2-year cost in the CTA scenario was $9,178, and for catheter angiography, $11,531, consistent with a $2,353 cost-savings per person for CTA. CTA resulted in accrual of 1.83 quality-adjusted life years while catheter angiography resulted in 1.82 quality-adjusted life years. CTA was less costly and marginally more effective than catheter angiography. In sensitivity analyses, when CTA sensitivity and specificity were allowed to vary across a plausible range, CTA remained cost-effective. CONCLUSIONS After screening examination has suggested an ICA occlusion, confirmatory testing with CTA provides similar effectiveness to catheter angiography and is less costly.
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Affiliation(s)
- Devin L Brown
- Stroke Program, University of Michigan, Ann Arbor, MI 48109-5855, USA.
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Okamura K, Uda K, Inoue T, Nakamizo A, Hirata Y, Yasumori K, Yasaka M, Okada Y. Treatment Strategy and Outcome of Surgical Treatment for an Atheromatous Pseudo-Occlusion of the Internal Carotid Artery. ACTA ACUST UNITED AC 2008. [DOI: 10.7887/jcns.17.857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Koichi Okamura
- Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center
| | - Ken Uda
- Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center
| | - Tooru Inoue
- Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center
| | - Akira Nakamizo
- Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center
| | - Yoko Hirata
- Department of Neurosurgery, Clinical Research Institute, National Kyushu Medical Center
| | | | - Masahiro Yasaka
- Department of Cerebrovascular Disease, Clinical Research Institute, National Kyushu Medical Center
| | - Yashushi Okada
- Department of Cerebrovascular Disease, Clinical Research Institute, National Kyushu Medical Center
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Collier W, Collier D, Wann S. Computed tomographic angiography of the carotid arteries. ACTA ACUST UNITED AC 2007; 5:250-1. [PMID: 17982297 DOI: 10.1111/j.1541-9215.2007.06091.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- William Collier
- Department of Cardiovascular Medicine, Wisconsin Heart Hospital, Milwaukee, WI 53226, USA
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Saba L, Sanfilippo R, Pirisi R, Pascalis L, Montisci R, Mallarini G. Multidetector-row CT angiography in the study of atherosclerotic carotid arteries. Neuroradiology 2007; 49:623-37. [PMID: 17607571 DOI: 10.1007/s00234-007-0244-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/25/2007] [Indexed: 11/28/2022]
Abstract
Pathologies of the carotid arteries, and in particular atherosclerosis, are now an important medical problem. Stroke is the third leading cause of severe disability in the Western World leading to millions of deaths every year. Extracranial carotid atherosclerotic disease is the major risk factor for stroke. In years, with the advent of multidetector-row CT (MDCT) scanners and the use of specific angiographic protocols (MDCTA), CT imaging of the carotid arteries has become increasingly effective. In addition, the volume data obtained can be further rendered to generate high-quality two-dimensional and three-dimensional images. The purpose of this study was to review the atherosclerotic carotid arteries, their complications and how MDCTA depicts them, underlining the benefits and pitfalls of this diagnostic technique.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Policlinico Universitario, s.s. 554 Monserrato, 09045 Cagliari, Italy.
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43
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Thanvi B, Robinson T. Complete occlusion of extracranial internal carotid artery: clinical features, pathophysiology, diagnosis and management. Postgrad Med J 2007; 83:95-9. [PMID: 17308211 PMCID: PMC2805948 DOI: 10.1136/pgmj.2006.048041] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A complete occlusion of the internal carotid artery (ICA) is an important cause of cerebrovascular disease. A never-symptomatic ICA occlusion has a relatively benign course, whereas symptomatic occlusion increases future risk of strokes. Ultrasonography, magnetic resonance imaging and contrast angiography are useful diagnostic tests, and functional imaging of the brain (eg, with positron emission tomography) helps to understand haemodynamic factors involved in the pathophysiology of brain ischaemia. Recently, there has been a resurgence of interest in the role of extracranial-intracranial bypass surgery for the treatment of completely occluded ICA. With advances in the measurement of cerebral haemodynamics, it may be possible to identify high-risk patients who could benefit from the bypass surgery.
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Affiliation(s)
- Bhomraj Thanvi
- Department of Integrated Medicine, Glenfield General Hospital, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK.
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44
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Pseudooclusión carotídea sintomática: tratamiento quirúrgico y resultados. ANGIOLOGIA 2007. [DOI: 10.1016/s0003-3170(07)75038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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45
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Bates ER, Babb JD, Casey DE, Cates CU, Duckwiler GR, Feldman TE, Gray WA, Ouriel K, Peterson ED, Rosenfield K, Rundback JH, Safian RD, Sloan MA, White CJ. ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting. J Am Coll Cardiol 2007; 49:126-70. [PMID: 17207736 DOI: 10.1016/j.jacc.2006.10.021] [Citation(s) in RCA: 233] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Computed tomography angiography (CTA) is a rapidly developing technology with great potential. This is particularly true for evaluating neurovascular disease. Clinical stroke because of atherosclerotic disease of the carotid and vertebral arteries is a common examination indication; areas of stenosis, and soft and calcified plaque along the entire vessel, not only at the carotid bifurcation, permit a full assessment of the patient's disease process. Other diseases including dissection, trauma, intracranial stenosis, thrombosis, and aneurysms can be readily diagnosed. Although duplex ultrasound may be a first line examination in many patients, both magnetic resonance angiography (MRA) and CTA offer distinct advantages over it. CTA and MRA are both highly accurate but CTA has several key advantages. CTA has been advanced by the development of improved multidetector CT (MDCT) and workstations that postprocess the data. Methods to obtain quality CTA images and to rapidly analyze the data for abnormalities are the subject of this chapter. In addition, evolving techniques in future CT scanners and workstations, and developing methods of vulnerable plaque and CT perfusion imaging are discussed.
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Affiliation(s)
- David S Enterline
- Division of Neuroradiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
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47
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Fortuño JR, Perendreu J, Falco J, Canovas D, Branera J. [Carotid stenosis: appropriate diagnosis and treatment]. RADIOLOGIA 2006; 48:119-36. [PMID: 17058634 DOI: 10.1016/s0033-8338(06)73143-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ischemic cerebral infarcts represent a serious health problem with important social and economic repercussions in the western world. The presence of carotid stenosis is one of the main risk factors for the appearance of cerebral infarcts. Carotid stenosis represents a challenge for the medical community, both because of the enormous amount of scientific information available and because of the constant advances in diagnostic procedures and especially in revascularization techniques for treatment. General radiologists as well as those specializing in vascular pathology need to have ample knowledge of how to reach the diagnosis and of the different treatment options for this pathology if they are to play a successful role in multidisciplinary teams dealing with carotid stenosis. This update aims to present the basic information that we consider to be essential in a simple way to enable radiologists to meet this challenge.
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Affiliation(s)
- J R Fortuño
- Unidad de Radiología Vascular e Intervencionista, Corporación Sanitaria Parc Taulí Sabadell, España.
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Fujimoto S, Toyoda K, Kishikawa K, Inoue T, Yasumori K, Ibayashi S, Iida M, Okada Y. Accuracy of Conventional plus Transoral Carotid Ultrasonography in Distinguishing Pseudo-Occlusion from Total Occlusion of the Internal Carotid Artery. Cerebrovasc Dis 2006; 22:170-6. [PMID: 16710083 DOI: 10.1159/000093451] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 01/30/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate the accuracy of conventional carotid ultrasonography (CCU) combined with transoral carotid ultrasonography (TOCU) for distinguishing pseudo-occlusion from total occlusion of the internal carotid artery (ICA). METHODS This study included 95 patients who were suspected of having an occlusion of the ICA on magnetic resonance angiography (MRA) and underwent both CCU and conventional digital subtraction angiography (DSA) in order to confirm the diagnosis. TOCU was also performed to observe the cervical portion of the ICA distal to the stenosis. We compared the ultrasonographic findings with the DSA findings. RESULTS Twelve of the 95 patients were defined as having an ICA pseudo-occlusion on DSA. On B-mode images with CCU color Doppler, slight residual flow signals in the ICA lumen were shown in 20 patients. Among them, 2 patients had a pulsed Doppler waveform of the distal ICA occlusion pattern. Among the remaining 18 patients, 4 had a pulsed Doppler waveform of the to and fro flow pattern, and 14 had a weak antegrade flow pattern in the ICA lumen. The conventional ultrasonographic method showed 100% sensitivity with 93% specificity for diagnosing an ICA pseudo-occlusion. The addition of TOCU findings increased the specificity to 98%. In 2 patients, who were overdiagnosed as having an ICA pseudo-occlusion even using TOCU, DSA revealed an occlusion of the ICA distal to the ophthalmic artery with a severe stenosis of the proximal ICA. CONCLUSIONS Using conventional and transoral carotid ultrasonography, an ICA pseudo-occlusion can be diagnosed with higher accuracy.
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Affiliation(s)
- Shigeru Fujimoto
- Department of Cerebrovascular Disease, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
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49
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Tahmasebpour HR, Buckley AR, Cooperberg PL, Fix CH. Sonographic examination of the carotid arteries. Radiographics 2006; 25:1561-75. [PMID: 16284135 DOI: 10.1148/rg.256045013] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) of the carotid arteries is a common imaging study performed for diagnosis of carotid artery disease. In the United States, carotid US may be the only diagnostic imaging modality performed before carotid endarterectomy. Therefore, the information obtained with carotid US must be reliable and reproducible. Technical parameters that can affect the accuracy of carotid US results include the Doppler angle, sample volume box, color Doppler sampling window, color velocity scale, and color gain. Important factors in diagnosis of atherosclerotic disease of the extracranial carotid arteries are the intima-media thickness, plaque morphology, criteria for grading stenosis, limiting factors such as the presence of dissection or cardiac abnormalities, distinction between near occlusion and total occlusion, and the presence of a subclavian steal. Challenges to the consistency of carotid US results may include lack of a standard protocol, poor Doppler technique, inexperience in interpretation of hemodynamic changes reflected in the Doppler waveform, artifacts, and physical challenges. Hindrances in the classification of problematic carotid artery stenoses may be overcome by following a standard protocol and optimizing scanning techniques and Doppler settings.
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Berczi V, Randall M, Balamurugan R, Shaw D, Venables GS, Cleveland TJ, Gaines PA. Safety of Arch Aortography for Assessment of Carotid Arteries. Eur J Vasc Endovasc Surg 2006; 31:3-7. [PMID: 16233982 DOI: 10.1016/j.ejvs.2005.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Accepted: 07/05/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE To retrospectively review the safety of arch aortography and compare complication rates with published figures for selective catheter angiography. METHODS The medical records of patients undergoing arch aortography over the last 3 years (n=311; 180 male, 131 female; mean+/-SD age 71.0+/-9.2 years, range 42-90 years) were retrospectively reviewed. Any peri-procedural (0-48 h) complications were recorded. A certified neurologist (MSR/GSV) classified all questionable neurological events. RESULTS There were no focal neurological events or deaths (n=0; 0%; CI: 0-0.96%). Non-focal neurological events included mild disorientation (n=2; 0.6%; CI: 0.176-2.31) and unequal pupils (n=1; 0.3%; CI: 0.056-1.79%). Cardiovascular events included symptomatic hypotension (n=4; 1.3%; CI: 0.50-3.25%), angina (n=1; 0.3%; CI: 0.056-1.79%) and arrhythmia (n=4; 1.3%; CI: 0.50-3.25). There were 27 minor access site complications (8.7%; CI: 6.0-12.3). None of these complications extended hospital stay. None of the arch angiograms had to be followed by selective carotid angiography. CONCLUSION Arch aortography appears to have a lower neurological complication rate than selective carotid angiography.
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Affiliation(s)
- V Berczi
- The Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK.
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