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Albricker ACL, Freire CMV, Santos SND, Alcantara MLD, Cantisano AL, Porto CLL, Amaral SID, Veloso OCG, Morais Filho DD, Teodoro JAR, Petisco ACGP, Saleh MH, Barros MVLD, Barros FS, Engelhorn ALDV, Engelhorn CA, Nardino ÉP, Silva MADM, Biagioni LC, Souza AJD, Sarpe AKP, Oliveira ACD, Moraes MRDS, Francisco Neto MJ, Françolin PC, Rochitte CE, Iquizli R, Santos AASMDD, Muglia VF, Naves BDL. Recommendation Update for Vascular Ultrasound Evaluation of Carotid and Vertebral Artery Disease: DIC, CBR and SABCV - 2023. Arq Bras Cardiol 2023; 120:e20230695. [PMID: 37991060 DOI: 10.36660/abc.20230695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Ana Cristina Lopes Albricker
- Centro Universitário de Belo Horizonte (UniBH), Belo Horizonte, MG - Brasil
- IMEDE - Instituto Mineiro de Ultrassonografia, Belo Horizonte, MG - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- Empresa Brasileira de Serviços Hospitalares (UBSERH), Brasília, DF - Brasil
| | | | | | | | | | | | - Orlando Carlos Glória Veloso
- Rede UnitedHealth Group (UHG), Rio de Janeiro, RJ - Brasil
- Hospital Pasteur, Rio de Janeiro, RJ - Brasil
- Hospital Américas, Rio de Janeiro, RJ - Brasil
- Hospital de Clínicas Mário Lioni, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Érica Patrício Nardino
- Faculdade de Medicina do ABC Paulista, SP - Brasil
- Faculdade de Medicina Unoeste, Guarujá, SP - Brasil
| | | | | | | | | | | | | | | | - Peter Célio Françolin
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (Hcor), São Paulo, SP - Brasil
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Polak JF, Alexandrov AV. Accuracy of the Society of Radiologists in Ultrasound (SRU) Carotid Doppler Velocity Criteria for Grading North American Symptomatic Carotid Endarterectomy Trial (NASCET) Stenosis: A Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1423-1435. [PMID: 36527708 DOI: 10.1002/jum.16150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE The Society of Radiologists in Ultrasound (SRU) consensus panel proposed six Doppler velocity cut points for classifying internal carotid artery (ICA) stenosis of 50% and 70% according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method. Their relative accuracies have not been compared. MATERIALS AND METHODS Meta-analysis performed following comprehensive literature review and identification of manuscripts with graphs of individual patient NASCET ICA stenosis measured by arteriography versus ICA peak-systolic velocity (PSV), end-diastolic velocity (EDV) and ICA PSV to common carotid artery (CCA) PSV. True positives, true negatives, false positives, and false negatives were calculated and used in two-level mixed effects models. Hierarchical summary receiver operating characteristic (ROC) curves were generated. Areas under the ROC curves were estimated. RESULTS Nine studies performed between 1993 and 2016 were identified after review of 337 manuscripts. There were 1738 bifurcation data points extracted for PSV, 1026 for EDV, and 775 for ICA/CCA ratio. The highest sensitivity was 96% (95% CI: 93%, 98%) for PSV of 125 cm/s (50% stenosis) and highest specificity 86% (95% CI: 71%, 93%) for PSV of 230 cm/s (70% stenosis). Areas under the ROC curves ranged from a high of 0.93 (95% CI: 0.92, 0.95) for PSV (50% stenosis) to a low of 0.86 (95% CI: 0.84, 0.88) for EDV (70% stenosis). CONCLUSIONS The SRU consensus Doppler cut points vary in their accuracies for predicting ICA stenosis. The PSV cut points have tradeoffs: high sensitivity/low specificity for 50% stenosis and high specificity/moderate sensitivity for 70% stenosis.
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Affiliation(s)
- Joseph F Polak
- Department of Radiology, Lemuel Shattuck Hospital, Tufts University School of Medicine and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Winzer S, Rickmann H, Kitzler H, Abramyuk A, Krogias C, Strohm H, Barlinn J, Pallesen LP, Siepmann T, Arnold S, Moennings P, Mudra H, Linn J, Reichmann H, Weiss N, Gahn G, Alexandrov A, Puetz V, Barlinn K. Ultrasonography Grading of Internal Carotid Artery Disease: Multiparametric German Society of Ultrasound in Medicine (DEGUM) versus Society of Radiologists in Ultrasound (SRU) Consensus Criteria. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:608-613. [PMID: 33951737 DOI: 10.1055/a-1487-5941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE We sought to determine the diagnostic agreement between the revised ultrasonography approach by the German Society of Ultrasound in Medicine (DEGUM) and the established Society of Radiologists in Ultrasound (SRU) consensus criteria for the grading of carotid artery disease. MATERIALS AND METHODS Post-hoc analysis of a prospective multicenter study, in which patients underwent ultrasonography and digital subtraction angiography (DSA) of carotid arteries for validation of the DEGUM approach. According to DEGUM and SRU ultrasonography criteria, carotid arteries were independently categorized into clinically relevant NASCET strata (normal, mild [1-49 %], moderate [50-69 %], severe [70-99 %], occlusion). On DSA, carotid artery findings according to NASCET were considered the reference standard. RESULTS We analyzed 158 ultrasonography and DSA carotid artery pairs. There was substantial agreement between both ultrasonography approaches for severe (κw 0.76, CI95 %: 0.66-0.86), but only fair agreement for moderate (κw 0.38, CI95 %: 0.19-0.58) disease categories. Compared with DSA, both ultrasonography approaches were of equal sensitivity (79.7 % versus 79.7 %; p = 1.0) regarding the identification of severe stenosis, yet the DEGUM approach was more specific than the SRU approach (70.2 % versus 56.4 %, p = 0.0002). There was equality of accuracy parameters (p > 0.05) among both ultrasonography approaches for the other ranges of carotid artery disease. CONCLUSION While the sensitivity was equivalent, false-positive identification of severe carotid artery stenosis appears to be more frequent when using the SRU ultrasonography approach than the revised multiparametric DEGUM approach.
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Affiliation(s)
- Simon Winzer
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Henning Rickmann
- Department of Neurology, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Hagen Kitzler
- Department of Neuroradiology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Andrij Abramyuk
- Department of Neuroradiology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Christos Krogias
- Department of Neurology, St.-Josef-Hospital, Ruhr University Bochum, Germany
| | - Henning Strohm
- Department of Cardiology, Municipal Hospital München-Neuperlach, Munich, Germany
| | - Jessica Barlinn
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Sebastian Arnold
- Department of Neuroradiology, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Peter Moennings
- Department of Neuroradiology, St.-Josef-Hospital, Ruhr University Bochum, Germany
| | - Harald Mudra
- Department of Neurology, St.-Josef-Hospital, Ruhr University Bochum, Germany
| | - Jennifer Linn
- Department of Neuroradiology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Norbert Weiss
- Center for Vascular Medicine and Department of Medicine III, Division of Angiology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Georg Gahn
- Department of Neurology, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Andrei Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, United States
| | - Volker Puetz
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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4
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Cassola N, Baptista-Silva JC, Nakano LC, Flumignan CD, Sesso R, Vasconcelos V, Carvas Junior N, Flumignan RL. Duplex ultrasound for diagnosing symptomatic carotid stenosis in the extracranial segments. Cochrane Database Syst Rev 2022; 7:CD013172. [PMID: 35815652 PMCID: PMC9272405 DOI: 10.1002/14651858.cd013172.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Carotid artery stenosis is an important cause of stroke and transient ischemic attack. Correctly and rapidly identifying patients with symptomatic carotid artery stenosis is essential for adequate treatment with early cerebral revascularization. Doubts about the diagnostic value regarding the accuracy of duplex ultrasound (DUS) and the possibility of using DUS as the single diagnostic test before carotid revascularization are still debated. OBJECTIVES To estimate the accuracy of DUS in individuals with symptomatic carotid stenosis verified by either digital subtraction angiography (DSA), computed tomography angiography (CTA), or magnetic resonance angiography (MRA). SEARCH METHODS We searched CRDTAS, CENTRAL, MEDLINE (Ovid), Embase (Ovid), ISI Web of Science, HTA, DARE, and LILACS up to 15 February 2021. We handsearched the reference lists of all included studies and other relevant publications and contacted experts in the field to identify additional studies or unpublished data. SELECTION CRITERIA We included studies assessing DUS accuracy against an acceptable reference standard (DSA, MRA, or CTA) in symptomatic patients. We considered the classification of carotid stenosis with DUS defined with validated duplex velocity criteria, and the NASCET criteria for carotid stenosis measures on DSA, MRA, and CTA. We excluded studies that included < 70% of symptomatic patients; the time between the index test and the reference standard was longer than four weeks or not described, or that presented no objective criteria to estimate carotid stenosis. DATA COLLECTION AND ANALYSIS The review authors independently screened articles, extracted data, and assessed the risk of bias and applicability concerns using the QUADAS-2 domain list. We extracted data with an effort to complete a 2 × 2 table (true positives, true negatives, false positives, and false negatives) for each of the different categories of carotid stenosis and reference standards. We produced forest plots and summary receiver operating characteristic (ROC) plots to summarize the data. Where meta-analysis was possible, we used a bivariate meta-analysis model. MAIN RESULTS We identified 25,087 unique studies, of which 22 were deemed eligible for inclusion (4957 carotid arteries). The risk of bias varied considerably across the studies, and studies were generally of moderate to low quality. We narratively described the results without meta-analysis in seven studies in which the criteria used to determine stenosis were too different from the duplex velocity criteria proposed in our protocol or studies that provided insufficient data to complete a 2 × 2 table for at least in one category of stenosis. Nine studies (2770 carotid arteries) presented DUS versus DSA results for 70% to 99% carotid artery stenosis, and two (685 carotid arteries) presented results from DUS versus CTA in this category. Seven studies presented results for occlusion with DSA as the reference standard and three with CTA as the reference standard. Five studies compared DUS versus DSA for 50% to 99% carotid artery stenosis. Only one study presented results from 50% to 69% carotid artery stenosis. For DUS versus DSA, for < 50% carotid artery stenosis, the summary sensitivity was 0.63 (95% confidence interval [CI] 0.48 to 0.76) and the summary specificity was 0.99 (95% CI 0.96 to 0.99); for the 50% to 69% range, only one study was included and meta-analysis not performed; for the 50% to 99% range, the summary sensitivity was 0.97 (95% CI 0.95 to 0.98) and the summary specificity was 0.70 (95% CI 0.67 to 0.73); for the 70% to 99% range, the summary sensitivity was 0.85 (95% CI 0.77 to 0.91) and the summary specificity was 0.98 (95% CI 0.74 to 0.90); for occlusion, the summary sensitivity was 0.91 (95% CI 0.81 to 0.97) and the summary specificity was 0.95 (95% CI 0.76 to 0.99). For sensitivity analyses, excluding studies in which participants were selected based on the presence of occlusion on DUS had an impact on specificity: 0.98 (95% CI 0.97 to 0.99). For DUS versus CTA, we found two studies in the range of 70% to 99%; the sensitivity varied from 0.57 to 0.94 and the specificity varied from 0.87 to 0.98. For occlusion, the summary sensitivity was 0.95 (95% CI 0.80 to 0.99) and the summary specificity was 0.91 (95% CI 0.09 to 0.99). For DUS versus MRA, there was one study with results for 50% to 99% carotid artery stenosis, with a sensitivity of 0.88 (95% CI 0.70 to 0.98) and specificity of 0.60 (95% CI 0.15 to 0.95); in the 70% to 99% range, two studies were included, with sensitivity that varied from 0.54 to 0.99 and specificity that varied from 0.78 to 0.89. We could perform only a few of the proposed sensitivity analyses because of the small number of studies included. AUTHORS' CONCLUSIONS This review provides evidence that the diagnostic accuracy of DUS is high, especially at discriminating between the presence or absence of significant carotid artery stenosis (< 50% or 50% to 99%). This evidence, plus its less invasive nature, supports the early use of DUS for the detection of carotid artery stenosis. The accuracy for 70% to 99% carotid artery stenosis and occlusion is high. Clinicians should exercise caution when using DUS as the single preoperative diagnostic method, and the limitations should be considered. There was little evidence of the accuracy of DUS when compared with CTA or MRA. The results of this review should be interpreted with caution because they are based on studies of low methodological quality, mainly due to the patient selection method. Methodological problems in participant inclusion criteria from the studies discussed above apparently influenced an overestimated estimate of prevalence values. Most of the studies included failed to precisely describe inclusion criteria and previous testing. Future diagnostic accuracy studies should include direct comparisons of the various modalities of diagnostic tests (mainly DUS, CTA, and MRA) for carotid artery stenosis since DSA is no longer considered to be the best method for diagnosing carotid stenosis and less invasive tests are now used as reference standards in clinical practice. Also, for future studies, the participant inclusion criteria require careful attention.
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Affiliation(s)
- Nicolle Cassola
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jose Cc Baptista-Silva
- Evidence Based Medicine, Cochrane Brazil, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis Cu Nakano
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina Dq Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ricardo Sesso
- Department of Medicine, Division of Nefrology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vladimir Vasconcelos
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Nelson Carvas Junior
- Evidence-Based Health Post-Graduation Program, Universidade Federal de São Paulo; Cochrane Brazil; Department of Physiotherapy, Universidade Paulista, São Paulo, Brazil
| | - Ronald Lg Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
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Abstract
Stroke is the fifth leading cause of death in the United States and is a leading cause of disability. Extracranial internal carotid artery stenosis is a major cause of ischemic stroke, as it is estimated to cause 8% to 15% of ischemic strokes. It is critical to improve our strategies for stroke prevention and treatment in order to reduce the burden of this disease. Herein, we review approaches for the diagnosis and risk stratification of carotid artery disease as well as interventional strategies for the prevention and treatment of strokes caused by carotid artery disease.
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Affiliation(s)
- Anna K Krawisz
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th Floor, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer Building, 4th Floor, Boston, MA 02215, USA
| | - Brett J Carroll
- Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer Building, 4th Floor, Boston, MA 02215, USA
| | - Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, 4th Floor, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Palmer Building, 4th Floor, Boston, MA 02215, USA.
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6
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Ahmed M, McPherson R, Abruzzo A, Thomas SE, Gorantla VR. Carotid Artery Calcification: What We Know So Far. Cureus 2021; 13:e18938. [PMID: 34815892 PMCID: PMC8605497 DOI: 10.7759/cureus.18938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 12/27/2022] Open
Abstract
Carotid artery calcification (CAC) is a well-known marker of atherosclerosis and is linked to a high rate of morbidity and mortality. CAC is divided into two types: intimal and medial calcifications, each with its own set of risk factors. Vascular calcification is now understood to be an active, enzymatically regulated process involving dystrophic calcification and endothelial dysfunction at an early stage. This causes a pathogenic inflammatory response, resulting in calcium phosphate deposition in the form of microcalcifications, which causes plaque formation, ultimately becoming unstable with sequelae of complications. If the inflammation goes away, hydroxyapatite crystal formation takes over, resulting in macro-calcifications that help to keep the plaque stable. As CAC can be asymptomatic, it is critical to identify it early using diagnostic imaging. The carotid artery calcification score is calculated using computed tomography angiography (CTA), which is a confirmatory test that enables the examination of plaque composition and computation of the carotid artery calcification score. Magnetic resonance angiography (MRA), which is sensitive as CTA, duplex ultrasound (DUS), positron emission tomography, and computed tomography (PET-CT) imaging with (18) F-Sodium Fluoride, and Optical Coherence Tomography (OCT) are some of the other diagnostic imaging modalities used. The current therapeutic method starts with the best medical care and is advised for all CAC patients. Carotid endarterectomy and carotid stenting are two treatment options that have mixed results in terms of effectiveness and safety. When patient age and anatomy, operator expertise, and surgical risk are all considered, the agreement is that both techniques are equally beneficial.
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Affiliation(s)
- Madeeha Ahmed
- Family Medicine, American University of Antigua College of Medicine, Antigua, ATG
| | - Regina McPherson
- Anatomical Sciences, American University of Antigua, St.John's, ATG
| | - Alexandra Abruzzo
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Sneha E Thomas
- Internal Medicine, University of Maryland Medical Center, Baltimore, USA
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7
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Retrospective analysis of two diagnostic tests: Carotid Doppler ultrasound and diagnostic cerebral angiography for carotid disease in the Mexican population. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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8
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Shen W, Tang D, Deng Y, Li H, Wang T, Wan P, Liu R. Association of gut microbiomes with lung and esophageal cancer: a pilot study. World J Microbiol Biotechnol 2021; 37:128. [PMID: 34212246 DOI: 10.1007/s11274-021-03086-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/02/2021] [Indexed: 12/16/2022]
Abstract
Gut microbiota, especially human pathogens, has been shown to be involved in the occurrence and development of cancer. Esophageal squamous cell carcinoma and lung cancer are two malignant cancers, and their relationship with gut microbiota is still unclear. Virulence factor database (VFDB) is an integrated and comprehensive online resource for curating information about human pathogens. Here, based on VFDB database, we analyzed the differences of bacteria at genus level in the gut of patients with esophageal squamous cell carcinoma, lung cancer, and healthy controls. We proposed the possible cancer-associated bacteria in gut and put forward their possible effects. Apart from this, principal coordinate analysis (PCoA) and analysis of similarities (ANSOIM) suggested that some bacteria in the gut can be used as potential biomarkers to screen esophageal squamous cell carcinoma and lung cancer, and their effectiveness was preliminary verified. The relative abundance of Klebsiella and Streptococcus can be used to distinguish patients with esophageal squamous cell carcinoma and lung cancer from healthy controls. The absolute abundance of Klebsiella can further distinguish patients with esophageal squamous cell carcinoma from patients with lung cancer. In particular, the relative abundance of Fusobacterium can directly distinguish between patients with esophageal squamous cell carcinoma and healthy controls. Additionally, the absolute abundance of Haemophilus can distinguish lung cancer from healthy controls. Our study provided a new way based on VFDB database to explore the relationship between gut microbiota and cancer, and initially proposed a feasible cancer screening method.
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Affiliation(s)
- Weitao Shen
- Key Laboratory of Environment Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Derong Tang
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Yali Deng
- Key Laboratory of Environment Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Huilin Li
- Key Laboratory of Environment Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Tian Wang
- Key Laboratory of Environment Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Ping Wan
- Key Laboratory of Environment Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China
| | - Ran Liu
- Key Laboratory of Environment Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, 210009, China.
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Gornik HL, Rundek T, Gardener H, Benenati JF, Dahiya N, Hamburg NM, Kupinski AM, Leers SA, Lilly MP, Lohr JM, Pellerito JS, Rholl KS, Vickery MA, Hutchisson MS, Needleman L. Optimization of duplex velocity criteria for diagnosis of internal carotid artery (ICA) stenosis: A report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee. Vasc Med 2021; 26:515-525. [PMID: 34009060 PMCID: PMC8493430 DOI: 10.1177/1358863x211011253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1/1/2009 and 12/31/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (κ = 0.42), with overestimation of degree of stenosis for both moderate (50–69%) and severe (⩾ 70%) ICA lesions. The primary SRUCC parameter for ⩾ 50% ICA stenosis of peak-systolic velocity (PSV) of ⩾ 125 cm/sec did not meet prespecified thresholds for adequate sensitivity, specificity, and accuracy (sensitivity 97.8%, specificity 64.2%, accuracy 74.5%). Test performance was improved by raising the PSV threshold to ⩾ 180 cm/sec (sensitivity 93.3%, specificity 81.6%, accuracy 85.2%) or by adding the additional parameter of ICA/common carotid artery (CCA) PSV ratio ⩾ 2.0 (sensitivity 94.3%, specificity 84.3%, accuracy 87.4%). For ⩾ 70% ICA stenosis, analysis was limited by a low number of cases with angiographically severe disease. Interpretation of carotid duplex examinations using SRUCC resulted in significant overestimation of severity of ICA stenosis when compared with angiography; raising the PSV threshold for ⩾ 50% ICA stenosis to ⩾ 180 cm/sec as a single parameter or requiring the ICA/CCA PSV ratio ⩾ 2.0 in addition to PSV of ⩾ 125 cm/sec for laboratories using the SRUCC is recommended to improve the accuracy of carotid duplex examinations.
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Affiliation(s)
- Heather L Gornik
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James F Benenati
- Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | | | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University, Boston, MA, USA
| | - Ann Marie Kupinski
- Albany Medical College, Albany, NY, USA.,North Country Vascular Diagnostics, Inc., Altamont, NY, USA
| | - Steven A Leers
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael P Lilly
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MA, USA
| | - Joann M Lohr
- Department of Surgery, Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
| | - John S Pellerito
- Department of Radiology, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Kenneth S Rholl
- Department of Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, George Washington University, Alexandria, VA, USA
| | | | - Marge S Hutchisson
- Intersocietal Accreditation Commission (IAC), Vascular Testing Division, Ellicott City, MD, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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10
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Hsu KC, Lin CH, Johnson KR, Liu CH, Chang TY, Huang KL, Fann YC, Lee TH. Autodetect extracranial and intracranial artery stenosis by machine learning using ultrasound. Comput Biol Med 2020; 116:103569. [PMID: 31999553 DOI: 10.1016/j.compbiomed.2019.103569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND and Purpose: This study proposed a machine learning method for identifying ≥50% stenosis of the extracranial and intracranial arteries. PATIENTS AND METHODS A total of 8211 patients with both carotid ultrasound and cerebral angiography were enrolled. Support vector machine (SVM) was employed as the machine learning classifier. Carotid Doppler parameters and transcranial Doppler parameters were used as the input features. Feature selection was performed using the Extra-Trees (extremely randomized trees) method. RESULTS For the machine learning method, the sensitivities and specificities of identifying stenosis of the extracranial arteries were 88.5%-100% and 96.0%-100%, respectively. The sensitivities and specificities of identifying stenosis of the intracranial arteries were 71.7%-100% and 88.9%-100%, respectively. CONCLUSIONS The SVM classifier with feature selection is an efficient method for identifying the stenosis of both intracranial and extracranial arteries. Comparing with traditional Doppler criteria, this machine learning method achieves up to 20% higher in accuracy and 45% in sensitivity, respectively.
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Affiliation(s)
- Kai-Cheng Hsu
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States; Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Heng Lin
- Center for Information Technology, National Institutes of Health, Bethesda, MD, United States
| | - Kory R Johnson
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Chi-Hung Liu
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Chang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Lun Huang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yang-Cheng Fann
- Bioinformatics Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, United States.
| | - Tsong-Hai Lee
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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11
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Marlevi D, Mulvagh SL, Huang R, DeMarco JK, Ota H, Huston J, Winter R, Macedo TA, Abdelmoneim SS, Larsson M, Pellikka PA, Urban MW. Combined spatiotemporal and frequency-dependent shear wave elastography enables detection of vulnerable carotid plaques as validated by MRI. Sci Rep 2020; 10:403. [PMID: 31942025 PMCID: PMC6962347 DOI: 10.1038/s41598-019-57317-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/25/2019] [Indexed: 12/29/2022] Open
Abstract
Fatal cerebrovascular events are often caused by rupture of atherosclerotic plaques. However, rupture-prone plaques are often distinguished by their internal composition rather than degree of luminal narrowing, and conventional imaging techniques might thus fail to detect such culprit lesions. In this feasibility study, we investigate the potential of ultrasound shear wave elastography (SWE) to detect vulnerable carotid plaques, evaluating group velocity and frequency-dependent phase velocities as novel biomarkers for plaque vulnerability. In total, 27 carotid plaques from 20 patients were scanned by ultrasound SWE and magnetic resonance imaging (MRI). SWE output was quantified as group velocity and frequency-dependent phase velocities, respectively, with results correlated to intraplaque constituents identified by MRI. Overall, vulnerable lesions graded as American Heart Association (AHA) type VI showed significantly higher group and phase velocity compared to any other AHA type. A selection of correlations with intraplaque components could also be identified with group and phase velocity (lipid-rich necrotic core content, fibrous cap structure, intraplaque hemorrhage), complementing the clinical lesion classification. In conclusion, we demonstrate the ability to detect vulnerable carotid plaques using combined SWE, with group velocity and frequency-dependent phase velocity providing potentially complementary information on plaque characteristics. With such, the method represents a promising non-invasive approach for refined atherosclerotic risk prediction.
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Affiliation(s)
- David Marlevi
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden. .,Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Sharon L Mulvagh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America.,Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Runqing Huang
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - J Kevin DeMarco
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, United States of America.,Department of Radiology, Uniformed Services University of Health Sciences, Bethesda, MD, United States of America
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - John Huston
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Reidar Winter
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Thanila A Macedo
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Sahar S Abdelmoneim
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Matilda Larsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Matthew W Urban
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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12
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Elías FR, Medina G, Sánchez M, Rios CS, Belmont GDLC, Danés LG. Carotid endarterectomy 20-year experience in a low-volume center. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_24_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Santos SND, Alcantara MLD, Freire CMV, Cantisano AL, Teodoro JAR, Porto CLL, Amaral SID, Veloso O, Albricker ACL, Petisco ACGP, Barros FS, Barros MVL, Saleh MH, Vieira MLC. Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology - 2019. Arq Bras Cardiol 2019; 112:809-849. [PMID: 31314836 PMCID: PMC6636370 DOI: 10.5935/abc.20190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | - Salomon Israel do Amaral
- Americas Medical City, Rio de Janeiro, RJ - Brazil.,Hospital Samaritano, Rio de Janeiro, RJ - Brazil
| | | | | | | | | | | | | | - Marcelo Luiz Campos Vieira
- Universidade de São Paulo (USP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP - Brazil
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14
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Saxena A, Ng EYK, Lim ST. Imaging modalities to diagnose carotid artery stenosis: progress and prospect. Biomed Eng Online 2019; 18:66. [PMID: 31138235 PMCID: PMC6537161 DOI: 10.1186/s12938-019-0685-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022] Open
Abstract
In the past few decades, imaging has been developed to a high level of sophistication. Improvements from one-dimension (1D) to 2D images, and from 2D images to 3D models, have revolutionized the field of imaging. This not only helps in diagnosing various critical and fatal diseases in the early stages but also contributes to making informed clinical decisions on the follow-up treatment profile. Carotid artery stenosis (CAS) may potentially cause debilitating stroke, and its accurate early detection is therefore important. In this paper, the technical development of various CAS diagnosis imaging modalities and its impact on the clinical efficacy is thoroughly reviewed. These imaging modalities include duplex ultrasound (DUS), computed tomography angiography (CTA) and magnetic resonance angiography (MRA). For each of the imaging modalities considered, imaging methodology (principle), critical imaging parameters, and the extent of imaging the vulnerable plaque are discussed. DUS is usually the initial recommended CAS diagnostic examination. However, for the therapeutic intervention, either MRA or CTA is recommended for confirmation, and for added information on intracranial cerebral circulation and aortic arch condition for procedural planning. Over the past few decades, the focus of CAS diagnosis has also shifted from pure stenosis quantification to plaque characterization. This has led to further advancement in the existing imaging tools and development of other potential imaging tools like Optical coherence tomography (OCT), photoacoustic tomography (PAT), and infrared (IR) thermography.
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Affiliation(s)
- Ashish Saxena
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, Block N3, Singapore, 639798, Singapore
| | - Eddie Yin Kwee Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, Block N3, Singapore, 639798, Singapore.
| | - Soo Teik Lim
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
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15
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Curtis N, Necas M, Versteeg M. The clinical implications of adopting new criteria for the grading of internal carotid artery stenosis. Australas J Ultrasound Med 2018; 21:36-44. [DOI: 10.1002/ajum.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nicole Curtis
- Vascular Laboratory; Level 2 Meade Clinical Centre; Waikato District Health Board; Selwyn Street and Pembroke Street Waikato, Hamilton 3204 New Zealand
| | - Martin Necas
- Vascular Laboratory; Level 2 Meade Clinical Centre; Waikato District Health Board; Selwyn Street and Pembroke Street Waikato, Hamilton 3204 New Zealand
| | - Matthew Versteeg
- Department of Surgical Sciences; Otago Vascular Diagnostics; University of Otago; 201 Great King Street Dunedin 9016 New Zealand
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16
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Strosberg DS, Haurani MJ, Satiani B, Go MR. Common carotid artery end-diastolic velocity and acceleration time can predict degree of internal carotid artery stenosis. J Vasc Surg 2017; 66:226-231. [PMID: 28390773 DOI: 10.1016/j.jvs.2017.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/24/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Whereas duplex ultrasound parameters for predicting internal carotid artery (ICA) stenosis are well defined, the use of common carotid artery (CCA) Doppler characteristics to predict ICA stenosis when the ICA cannot be insonated directly or accurately because of anatomy, calcification, or tortuosity has not been studied. The objective of this study was to identify CCA Doppler parameters that may predict ICA stenosis. METHODS We reviewed all patients at our institution who underwent carotid duplex ultrasound (CDU) from 2008 to 2015 and also had a comparison computed tomography, magnetic resonance, or catheter angiogram. We excluded patients whose CDU examination did not correlate with the comparison study, those whose arteries were not visualized on the comparison study, and those with complete occlusion of the CCA. We collected CCA peak systolic velocity (PSV), end-diastolic velocity (EDV), and acceleration time (AT) in addition to CDU and comparison imaging interpretation of degree of stenosis. A multivariate model was used to identify predictors of ICA stenosis. RESULTS There were 99 CDU examinations with corresponding comparison imaging included. For every increase of 10 cm/s in EDV in the CCA, the odds of a >50% ICA stenosis being present vs a ≤50% ICA stenosis decreased by 37% (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.41-0.97; P = .03). For every increase of 10 cm/s in EDV in the CCA, the odds of a 70% to 99% ICA stenosis being present vs a ≤50% ICA stenosis decreased by 48% (OR, 0.52; 95% CI, 0.28-0.94; P = .03). A CCA EDV of 19 cm/s or below was associated with a 64% probability of a 70% to 99% ICA stenosis. For every 50-millisecond increase in AT in the CCA, the odds of a >50% stenosis being present vs a ≤50% ICA stenosis increased by 56% (OR, 1.56; 95% CI, 1.03-2.35; P = .04). A CCA AT of 80 milliseconds or above was associated with a 69% probability of a >50% ICA stenosis. There was no correlation between CCA PSV and ICA stenosis. CONCLUSIONS CCA EDV and AT are independent predictors of ICA stenosis and may be used in the setting of patients whose ICA cannot be directly insonated or when standard duplex ultrasound parameters of ICA PSV, EDV, or ICA/CCA ratio conflict.
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Affiliation(s)
- David S Strosberg
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Mounir J Haurani
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bhagwan Satiani
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael R Go
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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17
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Carnicelli AP, Stone JJ, Doyle A, Chowdhry A, Gillespie DL, Chandra A. Predictive Multivariate Regression to Increase the Specificity of Carotid Duplex Ultrasound for High-grade Stenosis in Asymptomatic Patients. Ann Vasc Surg 2014; 28:1548-55. [DOI: 10.1016/j.avsg.2014.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/18/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022]
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18
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Doyle AJ, Stone JJ, Carnicelli AP, Chandra A, Gillespie DL. CT Angiography–derived Duplex Ultrasound Velocity Criteria in Patients with Carotid Artery Stenosis. Ann Vasc Surg 2014; 28:1219-26. [DOI: 10.1016/j.avsg.2013.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/20/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
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19
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Kalashyan H, Shuaib A, Gibson PH, Romanchuk H, Saqqur M, Khan K, Osborne J, Becher H. Single sweep three-dimensional carotid ultrasound: Reproducibility in plaque and artery volume measurements. Atherosclerosis 2014; 232:397-402. [DOI: 10.1016/j.atherosclerosis.2013.11.079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/13/2013] [Accepted: 11/27/2013] [Indexed: 11/17/2022]
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20
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Bryant CE, Pugh ND, Coleman DP, Morris RJ, Williams PT, Humphries KN. Comparison of Doppler ultrasound velocity parameters in the determination of internal carotid artery stenosis. ULTRASOUND 2013. [DOI: 10.1177/1742271x13496680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to compare the evidence base and practical results of the Joint Recommendations for Reporting Carotid Ultrasound Investigations in UK, published in 2009, and existing carotid scan protocols based on the Society of Radiologists in Ultrasound 2003 Consensus. A prospective sequential evaluation of the 2009 recommendations was performed at the University Hospital of Wales, Cardiff. Additional measurements in line with the recommendations were made during carotid scans. The grading of internal carotid artery stenosis using the 2003 and 2009 UK recommendations, and recommended measures of PSV, PSV ratio and St Mary’s ratio were compared. In comparison to PSV classification, PSV ratio produced lower stenosis classification in 29% and 24% of cases in the 50–69% and 70–89% stenosis bands respectively. St Mary’s ratio produced poor classification agreement across all bands, particularly the 50%–69% stenosis band. Agreement of two measures is recommended for diagnostic confidence; however, in the 50%–69% and 70%–89% stenosis bands, agreement of two measures only occurred in 70% of scans. This evaluation suggests that the use of three measurements in the 2009 recommendations complicates rather than aids diagnosis, especially in the 50%–69% and 70%–89% stenosis bands, and does not provide significant improvement over the 2003 guidelines. No evidence was found to support the combined use of the three measures.
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Affiliation(s)
- CE Bryant
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK
| | - ND Pugh
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK
| | - DP Coleman
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK
| | - RJ Morris
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK
| | - PT Williams
- Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, UK
| | - KN Humphries
- School of Engineering, Cardiff University, Cardiff, UK
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21
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Flemming KD. Diagnosis of Stroke Mechanisms and Secondary Prevention. Stroke 2013. [DOI: 10.1002/9781118560730.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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22
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Giurgea GA, Lilaj I, Gschwandtner ME, Margeta C, Zehetmayer S, Domenig C, Schlager O, Schwameis M, Koppensteiner R, Willfort-Ehringer A. Poor agreement in carotid artery stenosis detection by ultrasound between external offices and a vascular center. Wien Klin Wochenschr 2012. [PMID: 23179431 DOI: 10.1007/s00508-012-0259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Carotid duplex ultrasonography is the prime investigation used to grade carotid artery stenosis in clinical routine. We compared the carotid ultrasound (US) scans performed externally with our results. MATERIALS AND METHODS This retrospective study included 288 patients who had been referred to our outpatient department and initially presented with an external carotid duplex scan report indicating carotid atherosclerosis. The external scans were analyzed and compared with our scans in respect of the accuracy of identification and quantification of stenosis, the criteria used to grade stenosis and the duplex criteria used. Weighted Kappa coefficients (K) were computed to quantify the agreement between internal and external findings. RESULTS The majority of the external reports had been performed by radiologists [70.8 % (n = 204)], followed by specialists of internal medicine [19.4 (n = 56)] and by neurologists [9.8 % (n = 28)]. Only slight agreement was registered between the external reports and those performed at our institution with regard to the identification of stenosis (K = 0.2 for the left and K = 0.12 for the right side). Greater agreement was observed in respect of the level of stenosis (K = 0.42 for the right and K = 0.54 for the left side). Overestimation of the level of stenosis was registered for 45 % in the left internal carotid artery (ICA) and 36 % in the right ICA; the overestimation was most pronounced for occlusions and high-grade stenoses, which is a source of great concern for decision-making. CONCLUSIONS The present data indicate only a slight agreement between carotid duplex US imaging performed at medical offices and our results.
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Affiliation(s)
- Georgiana-Aura Giurgea
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
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23
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Taki H, Taki K, Sakamoto T, Yamakawa M, Shiina T, Kudo M, Sato T. High range resolution ultrasonographic vascular imaging using frequency domain interferometry with the Capon method. IEEE TRANSACTIONS ON MEDICAL IMAGING 2012; 31:417-429. [PMID: 21984496 DOI: 10.1109/tmi.2011.2170847] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
For high range resolution ultrasonographic vascular imaging, we apply frequency domain interferometry with the Capon method to a single frame of in-phase and quadrature (IQ) data acquired using a commercial ultrasonographic device with a 7.5 MHz linear array probe. In order to tailor the adaptive beam forming algorithm for ultrasonography we employ four techniques: frequency averaging, whitening, radio-frequency data oversampling, and the moving average. The proposed method had a range resolution of 0.05 mm in an ideal condition, and experimentally detected the boundary couple 0.17 mm apart, where the boundary couple was indistinguishable from a single boundary utilizing a B-mode image. Further, this algorithm could depict a swine femoral artery with a range beam width of 0.054 mm and an estimation error for the vessel wall thickness of 0.009 mm, whereas using a conventional method the range beam width and estimation error were 0.182 and 0.021 mm, respectively. The proposed method requires 7.7 s on a mobile PC with a single CPU for a 1×3 cm region of interest. These findings indicate the potential of the proposed method for the improvement of range resolution in ultrasonography without deterioration in temporal resolution, resulting in enhanced detection of vessel stenosis.
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Affiliation(s)
- Hirofumi Taki
- Graduate School of Informatics, Kyoto University,Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
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24
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Aleksic N, Tanaskovic S, Radak S, Mitrasinovic A, Kolar J, Babic S, Otasevic P, Radak D. Color duplex sonography in the detection of internal carotid artery restenosis after carotid endarterectomy: comparison with computed tomographic angiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1677-1682. [PMID: 22124003 DOI: 10.7863/jum.2011.30.12.1677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Internal carotid artery restenosis after carotid endarterectomy is a major postoperative event, but the clinically best suited means for diagnosis of restenosis are still debated. The objective of this study was to evaluate the sensitivity and specificity of color duplex sonography for detection of substantial internal carotid artery restenosis, verified by computed tomographic (CT) angiography. METHODS The study group consisted of 210 consecutive patients with internal carotid artery restenosis, defined as restenosis of 50% or greater, verified by color duplex sonography. The degree of restenosis was calculated according to the European Carotid Surgery Trial guidelines. All patients underwent CT angiography. The specificity, sensitivity, positive predictive value, and negative predictive value of color duplex sonography were calculated. RESULTS In 85 patients, internal carotid artery restenosis on color duplex sonography was 50% to 69%, whereas in 125 patients it was 70% or greater. When color duplex sonography was compared with CT angiography, only 2 patients in the group with restenosis of 50% to 69% were misclassified by color duplex sonography, in whom CT angiography showed stenosis of 70% or greater. No patient with stenosis of 70% or greater on color duplex sonography was shown to have a lesser degree of restenosis on CT angiography. When compared with CT angiography, color duplex sonography had specificity of 97.7%, sensitivity of 100%, a positive predictive value of 98.4%, and a negative predictive value of 100% for the detection of internal carotid artery restenosis. CONCLUSIONS Color duplex sonography can be effectively used as a primary diagnostic tool for evaluation of patients with suspected internal carotid artery restenosis after carotid endarterectomy.
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Affiliation(s)
- Nikola Aleksic
- Vascular Surgery Clinic, Dedinje Cardiovascular Institute, Milana Tepića 1, 11040 Belgrade, Serbia.
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25
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Carotid artery atheromas and calcifications among postmenopausal women with histories of cerebrovascular or cardiovascular problems. Oral Radiol 2011. [DOI: 10.1007/s11282-011-0073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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26
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AbuRahma AF, Srivastava M, Stone PA, Mousa AY, Jain A, Dean LS, Keiffer T, Emmett M. Critical appraisal of the Carotid Duplex Consensus criteria in the diagnosis of carotid artery stenosis. J Vasc Surg 2011; 53:53-9; discussion 59-60. [DOI: 10.1016/j.jvs.2010.07.045] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/19/2010] [Accepted: 07/20/2010] [Indexed: 10/18/2022]
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27
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Slovut DP, Romero JM, Hannon KM, Dick J, Jaff MR. Detection of common carotid artery stenosis using duplex ultrasonography: A validation study with computed tomographic angiography. J Vasc Surg 2010; 51:65-70. [DOI: 10.1016/j.jvs.2009.08.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 08/01/2009] [Accepted: 08/01/2009] [Indexed: 11/29/2022]
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28
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Results of carotid endarterectomy with pericardial patch angioplasty: rate and predictors of restenosis. Ann Vasc Surg 2008; 21:767-71. [PMID: 17980796 DOI: 10.1016/j.avsg.2007.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 05/11/2007] [Accepted: 07/13/2007] [Indexed: 11/22/2022]
Abstract
Routine patch angioplasty after carotid endarterectomy (CEA) is believed to decrease the incidence of recurrent stenosis. The results of autogenous vein, Dacron, and PTFE used as a patch material have been described. Bovine pericardium has more recently been introduced as a patch material. We studied 61 of 73 consecutive patients who underwent isolated CEA with pericardial patch angioplasty to determine the incidence of restenosis and variables associated with restenosis. All patients had intraoperative completion duplex examination performed, and no patient had residual stenosis or anatomic defects at the end of the procedure. All procedures were performed under general anesthesia with the use of a Javid shunt. Mean age was 72.8 +/- 7.8 years, 41% were female, and 62% were asymptomatic. Hypertension was present in 72%, elevated cholesterol in 80%, and history of coronary artery disease in 44%. Recurrent stenosis of >50% was considered to be significant. Our study focuses on 61 of 73 patients who had follow-up duplex ultrasound data available. There were no perioperative neurologic events, reoperations for bleeding, or deaths. Mean duplex follow-up available in 61 patients was 13.1 +/- 5.1 months. Thirty-six patients had 1-15% stenosis, 15 patients had 16-49%, and 10 patients had 50-79%. In the 50-79% group, the mean systolic velocity was 154 +/- 25 cm/sec and the mean end diastolic velocity (EDV) was 36 +/- 16 cm/sec. The highest EDV in the 50-79% group was 56 cm/sec. No patients had stenosis in the 80-99% range. There were no late neurologic events and no late reinterventions. Kaplan-Meier restenosis-free survival at 1 year was 95.6%. Significant univariate predictors of recurrent stenosis of >50% were younger age (68 vs. 74 years, p = 0.04) and presence of preoperative symptomatic disease (35% vs. 5%, p = 0.004). Stepwise multiple logistic regression indicated the most significant predictor of restenosis was the presence of preoperative symptoms (p = 0.008). Stepwise Cox regression analysis also showed preoperative symptomatic status was the only significant factor for restenosis (p = 0.019), with a relative risk of 6.65 and a 95% confidence interval of 1.36-32.4. In conclusion, pericardial patch angioplasty is associated with minimal early adverse events. Restenosis with pericardial patch angioplasty is not uncommon, but high-grade restenosis did not occur in this study. The presence of preoperative symptoms and younger age were the most significant predictors of restenosis.
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Affiliation(s)
- Robert A Taylor
- Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota, USA.
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Chua HC, Arul Earnest YY, Venketasubramanian N. Detection of Internal Carotid Artery Stenosis with Duplex Velocity Criteria Using Receiver Operating Characteristic Analysis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n4p247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Duplex ultrasonography is an excellent non-invasive screening tool for carotid artery stenosis. The aim of this study was to evaluate optimal ultrasonographic criteria for determination of internal carotid artery stenosis with reference to digital subtraction angiogra-phy.
Materials and Methods: From January 1995 to December 2003, 114 symptomatic patients underwent both duplex ultrasonography and angiography. Seven velocity criteria were com-pared with angiographic stenosis and receiver operating characteristic curves were used to determine the best cutoff for each criteria.
Results: Internal carotid artery/common carotid artery systolic velocity ratios (PSV ICA/PSV CCA) and systolic internal carotid artery/diastolic common carotid artery ratios (PSV ICA/EDV CCA) were superior to other criteria for diagnosing internal carotid artery stenosis. For 50% stenosis, the best criterion of PSV ICA/PSV CCA was 1.5 [sensitivity 100%, specificity 85%, area under the curve (AUC) 99%], and the best criterion of PSV ICA/EDV CCA was 3.5 (sensitivity 100%, specificity 58%, AUC 99%). For 60% stenosis, the best criterion of PSV ICA/PSV CCA was 2.6 (sensitivity 100%, specificity 94%, AUC 99%), and the best criterion of PSV ICA/EDV CCA was 10.3 (sensitivity 100%, specificity 96%, AUC 99%). For 70% stenosis, the best criterion of PSV ICA/PSV CCA was 3.1 (sensitivity 100%, specificity 91%, AUC 99%), and the best criterion of PSV ICA/EDV CCA was 10.3 (sensitivity 100%, specificity 91%, AUC 99%).
Conclusion: Our study showed that velocity ratios are superior to other criteria for detecting carotid stenosis. Each laboratory needs to validate its own results.
Key words: Angiography, Duplex, Extracranial, Internal carotid artery
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Hugl B, Oldenburg WA, Neuhauser B, Hakaim AG. Effect of Age and Gender on Restenosis after Carotid Endarterectomy. Ann Vasc Surg 2006; 20:602-8. [PMID: 17019658 DOI: 10.1007/s10016-006-9028-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 02/14/2006] [Accepted: 02/17/2006] [Indexed: 10/24/2022]
Abstract
Several studies have suggested that the benefits of CEA may be gender-dependent. The purpose of this study was to focus on age and gender outcomes after CEA. Three hundred seventy-two CEAs were performed in 344 patients (115 females, 229 males; mean age 72.9 years). Mean follow-up was 25.8 months. Data were collected retrospectively by chart review, and follow-up data were obtained by clinical examination and duplex ultrasound. Recurrent stenosis was defined as >50% and/or occlusion. Three hundred and seventy-two CEAs were performed in 120 female and 252 male carotid arteries: 97.3% of patients underwent patch angioplasty (bovine pericardium 71.5%, Dacron 21.8%, vein 3.8%, and polytetrafluoroethylene 0.3%) and 2.7% of patients underwent eversion endarterectomy. Perioperative mortality rate (30-day) was 0.8% (0% of females vs. 1.2% of males), and stroke rate was 0.5% (1.7% of females vs. 0% of males), with no significant gender difference (p = 0.554 and p = 0.103, respectively). Follow-up ultrasound revealed 21 (7%) restenoses (>50%) and/or occlusions, with a significantly higher rate of restenosis in females (14% vs. 3.9% in males, p = 0.008) and in patients <70 years of age at time of surgery (p = 0.003). There was no age difference between women and men with restenosis. Although there was no statistical difference in occurrence of restenosis between Dacron and bovine patch (p = 0.62), females who underwent patch angioplasty with Dacron were more likely to develop restenosis (p = 0.052). CEA is a low-risk procedure for significant carotid stenosis; however, females are more likely to develop restenosis after carotid surgery, especially with Dacron patches. Younger patients appear to be at a higher risk of restenosis after surgery.
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Affiliation(s)
- Beate Hugl
- Section of Vascular Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
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Telman G, Kouperberg E, Sprecher E, Gruberg L, Beyar R, Hoffman A, Yarnitsky D. Duplex Ultrasound Verified by Angiography in Patients with Severe Primary and Restenosis of Internal Carotid Artery. Ann Vasc Surg 2006; 20:478-81. [PMID: 16642286 DOI: 10.1007/s10016-006-9049-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 01/03/2006] [Accepted: 02/17/2006] [Indexed: 10/24/2022]
Abstract
There are very limited data in the literature about the reliability of duplex ultrasound (DU) verified by angiography in patients with restenosis of the internal carotid artery (ICA) after carotid surgery compared with primary carotid artery stenosis patients. Our objective was to compare the reliability of DU verified by conventional angiography in the diagnosis of severe primary stenosis versus restenosis of ICA. One hundred thirty-four patients (238 arteries) were examined by both DU and angiography. Severe stenosis (>70%) was found in 47 primary stenotic arteries and in 70 restenotic arteries. Accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value were obtained for basic DU criteria after verification of ultrasound data by angiography. The best accuracy for detection of >70% stenosis by end diastolic velocity was found for the velocity of 70 cm/sec or more in both groups, but accuracy for the restenosis group was significantly higher (96.9% vs. 89.8%, p = 0.025). Additionally, specificity (p = 0.01) and PPV (p = 0.01) were significantly higher in the restenosis group. The best accuracy for detection of >70% stenosis by peak systolic velocity was found for the velocity of 220 cm/sec or more for restenoses and 200 cm/sec or more for primary stenoses. The accuracy of the ultrasound was significantly higher in the restenosis group (94.6% vs. 87%, p = 0.04), as were specificity (p = 0.01) and PPV (p = 0.02). The diagnosis of severe restenosis by DU is reliable and can be used for decision making regarding surgery or stenting without angiography. In patients with Doppler parameters pointing to borderline moderate/severe primary carotid stenosis and technically complicated cases, angiography in addition to sonography before surgery is recommended.
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Affiliation(s)
- Gregory Telman
- Department of Neurology, Rambam Medical Center, Haifa, Israel.
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Goldman CK, Morshedi-Meibodi A, White CJ, Jaff MR. Surveillance imaging for carotid in-stent restenosis. Catheter Cardiovasc Interv 2006; 67:302-8. [PMID: 16400679 DOI: 10.1002/ccd.20515] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Carotid artery stent placement is the procedure of choice in suitable candidates who require carotid revascularization and are at increased risk for surgical therapy. To ensure late patency of the stent, continued surveillance is required. We present three cases to illustrate the strengths and weaknesses of noninvasive imaging techniques for surveillance of carotid stents, ultimately validated with invasive contrast angiography.
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Affiliation(s)
- Corey K Goldman
- Division of Vascular Medicine, Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
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Heijenbrok-Kal MH, Nederkoorn PJ, Buskens E, van der Graaf Y, Hunink MGM. Diagnostic Performance of Duplex Ultrasound in Patients Suspected of Carotid Artery Disease. Stroke 2005; 36:2105-9. [PMID: 16151031 DOI: 10.1161/01.str.0000181753.40455.07] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate duplex ultrasonographic thresholds for the determination of 70% to 99% stenosis of the ipsilateral and contralateral internal carotid artery in patients with symptoms of amaurosis fugax, transient ischemic attack (TIA), or minor stroke based on 2 criteria: maximizing accuracy and optimizing cost-effectiveness and to compare these with current recommendations. METHODS From January 1997 to January 2000, a prospective multicenter study was conducted including 350 consecutive patients with symptoms of amaurosis fugax, TIA, or minor stroke who underwent bilateral duplex ultrasonography and digital subtraction angiography. A linear regression analysis was performed to estimate the degree of angiographic stenosis as a function of the peak systolic velocity (PSV). PSV thresholds were calculated for the ipsilateral and contralateral carotid arteries based on maximizing accuracy and optimizing cost-effectiveness. RESULTS The PSV measurements significantly overestimated the angiographic stenosis in the contralateral artery (9.5%; 95% CI, 6.3% to 12.7%) compared with the ipsilateral carotid artery. The recommended PSV threshold for the diagnosis of 70% to 99% stenosis is 230 cm/s. Maximizing accuracy, the optimal PSV threshold for the ipsilateral artery was 280 cm/s, and for the contralateral artery, 370 cm/s for diagnosing a 70% to 99% stenosis. Optimizing cost-effectiveness, the optimal PSV threshold was 220 cm/s for ipsilateral and 290 cm/s for contralateral carotid arteries. CONCLUSIONS PSV measurements overestimate the degree of angiographic stenosis in the contralateral carotid artery in patients with symptoms of amaurosis fugax, TIA, or minor stroke. Separate PSV thresholds should be used for the ipsilateral and contralateral carotid artery. PSV thresholds that optimize cost-effectiveness differ from the recommended thresholds and from thresholds that maximize accuracy.
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Affiliation(s)
- Majanka H Heijenbrok-Kal
- Department of Epidemiology and Biostatistics, Erasmus MC-University Medical Center Rotterdam, The Netherlands.
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Gautier C, Leclerc X, Pruvo JP, Deklunder G. Place de l’écho-Doppler cervico-encéphalique dans l’ischémie cérébrale. ACTA ACUST UNITED AC 2005; 86:1105-14. [PMID: 16227906 DOI: 10.1016/s0221-0363(05)81501-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Carotid stenosis is a common cause of ischemic stroke. The management of patients with a carotid lesion is mainly based on the degree of stenosis. Ultrasonography is a reliable and accurate method of quantification of the stenosis. The sonographic quantification is based on both velocity and morphological criteria. B mode, color or power Doppler as well as spectral Doppler are used for this purpose. The actual velocity criteria for a 70% stenosis (NASCET definition) are as follows: maximal systolic velocity above 230 cm.s-1, telediastolic velocity above 100 cm.s-1, carotid ratio above 4. The morphological quantification of the stenosis relies on Doppler imaging and B-mode coupling. With ultrasound, the residual area can be measured using a short axis plane, and the diameter reduction using a longitudinal plane. The different parameters provide complementary information that must be in agreement with one another. There is a growing interest in plaque characterization. Undoubtedly plaque structure and surface appearance also play a role in the individual risk of stroke. Thus, B-mode plaque analysis must be an integral part of the ultrasonographic examination. Transcranial Doppler is a complementary investigation that can be used to evaluate the hemodynamic consequences of the stenosis and to look for intracranial lesions. Optimal sonographic examination currently allows comprehensive evaluation of a carotid lesion.
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Affiliation(s)
- C Gautier
- Service des EFCV, Hôpital Cardiologique, CHRU Lille.
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36
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Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS) phase I clinical trial: 1-year results. J Vasc Surg 2005; 42:213-9. [PMID: 16102616 DOI: 10.1016/j.jvs.2005.04.023] [Citation(s) in RCA: 189] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 04/14/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Current clinical trials evaluating carotid stenting have focused on high-risk patients and may not reflect the broad population of patients with carotid stenosis who undergo treatment to prevent stroke. The Carotid Revascularization Using Endarterectomy or Stenting Systems (CaRESS) phase I study is a multicenter, prospective, nonrandomized trial designed to address the question of whether carotid stenting (CAS) with cerebral protection is comparable to carotid endarterectomy (CEA) in patients with symptomatic and asymptomatic carotid stenosis. METHODS Patients with symptomatic (with >50% stenosis) or asymptomatic (with >75% stenosis) carotid stenosis were entered into the study in a 2:1 ratio of carotid stent and GuardWire Plus distal protection device. This unique trial model was developed through collaboration with the International Society of Endovascular Specialists, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, the National Institutes of Health, and industry representatives. The primary end points included death and stroke at 30 days and a composite 1-year end point of death, stroke, or myocardial infarction (MI) from 0 to 30 days and death or stroke from 31 days to 1 year. The secondary end points included residual stenosis, restenosis, repeat angiography, and carotid revascularization at 30 days and 1 year and quality-of-life changes at 1 year. RESULTS A total of 397 patients (254 CEA and 143 CAS) were enrolled in the study: 32% were symptomatic and 68% were asymptomatic. There were no significant differences in patient characteristics, symptoms, or surgical risk profiles between groups at baseline. Kaplan-Meier analysis revealed no significant differences in combined death/stroke rates at 30 days (3.6% CEA vs 2.1% CAS) or at 1 year (13.6% CEA vs 10.0% CAS). Similarly, there was no significant difference in the combined end point of death, stroke, or MI at 30 days (4.4% CEA vs 2.1% CAS) or at 1 year (14.3% CEA vs 10.9% CAS). There were no significant differences between CEA and CAS in the secondary end points of residual stenosis (0% CEA vs 0.9% CAS), restenosis (3.6% CEA vs 6.3% CAS), repeat angiography (2.1% CEA vs 3.6% CAS), carotid revascularization (1.0% CEA vs 1.8% CAS), or change in quality of life (-1.56 points CEA vs -4.22 points CAS). CONCLUSIONS The CaRESS phase I study suggests that the 30-day and 1-year risk of death, stroke, or MI with CAS is equivalent to that with CEA in symptomatic and asymptomatic patients with carotid stenosis.
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Jahromi AS, Cinà CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: A systematic review and meta-analysis. J Vasc Surg 2005; 41:962-72. [PMID: 15944595 DOI: 10.1016/j.jvs.2005.02.044] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Duplex ultrasound is widely used for the diagnosis of internal carotid artery stenosis. Standard duplex ultrasound criteria for the grading of internal carotid artery stenosis do not exist; thus, we conducted a systematic review and meta-analysis of the relation between the degree of internal carotid artery stenosis by duplex ultrasound criteria and degree of stenosis by angiography. METHODS Data were gathered from Medline from January 1966 to January 2003, the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, ACP Journal Club, UpToDate, reference lists, and authors' files. Inclusion criteria were the comparison of color duplex ultrasound results with angiography by the North American Symptomatic Carotid Endarterectomy Trial method; peer-reviewed publications, and >/=10 adults. RESULTS Variables extracted included internal carotid artery peak systolic velocity, internal carotid artery end diastolic velocity, internal carotid artery/common carotid artery peak systolic velocity ratio, sensitivity and specificity of duplex ultrasound scanning for internal carotid artery stenosis by angiography. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria were used to assess study quality. Sensitivity and specificity for duplex ultrasound criteria were combined as weighted means by using a random effects model. The threshold of peak systolic velocity >/=130 cm/s is associated with sensitivity of 98% (95% confidence intervals [CI], 97% to 100%) and specificity of 88% (95% CI, 76% to 100%) in the identification of angiographic stenosis of >/=50%. For the diagnosis of angiographic stenosis of >/=70%, a peak systolic velocity >/=200 cm/s has a sensitivity of 90% (95% CI, 84% to 94%) and a specificity of 94% (95% CI, 88% to 97%). For each duplex ultrasound threshold, measurement properties vary widely between laboratories, and the magnitude of the variation is clinically important. The heterogeneity observed in the measurement properties of duplex ultrasound may be caused by differences in patients, study design, equipment, techniques or training. CONCLUSIONS Clinicians need to be aware of the limitations of duplex ultrasound scanning when making management decisions.
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Affiliation(s)
- Afshin S Jahromi
- Division of Vascular Surgery, McMaster University, Toronto, Ontario, Canada
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Kubale R, Arning C. [Significance of Doppler ultrasound procedures for diagnosis of carotid stenoses]. Radiologe 2005; 44:946-59. [PMID: 15549220 DOI: 10.1007/s00117-004-1118-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Determining degree and morphology of stenoses is important for surgical planning or stent implantation. Vascular ultrasound is usually the first modality to evaluate carotid artery stenosis. Due to rapid development various methods of vascular ultrasound are applied including continuous wave (CW) Doppler, duplex Doppler, colour-coded duplex sonography (CCDS), power Doppler and B-flow technique. For quantitative assessment of the degree of stenosis the most frequently used parameters are peak systolic velocity (PSV), end-diastolic velocity (EDV) in the internal carotid artery (ICA), as well as ICA to CCA ratios of PSV and EDV. Different results reported in the literature may reflect differences in defining the degree of stenosis and methodological differences in protocol or imaging techniques. Differences in defining the degree of stenosis, advantages and disadvantages of the different Doppler techniques and future developments are discussed in detail.
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Affiliation(s)
- R Kubale
- Institut für Radiologie, Sonographie und Nuklearmedizin, Pirmasens.
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Herzig R, Burval S, Krupka B, Vlachová I, Urbánek K, Mares J. Comparison of ultrasonography, CT angiography, and digital subtraction angiography in severe carotid stenoses. Eur J Neurol 2004; 11:774-81. [PMID: 15525300 DOI: 10.1111/j.1468-1331.2004.00878.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Digital subtraction angiography (DSA) is considered to be the 'gold standard' for confirmation of severe (70-99%) stenoses of internal carotid arteries (ICAs). However, it is associated with a risk of complications. The aim of this study was to assess the accuracy of ultrasonography (US), computed tomographic angiography (CTA), and their combined use for the detection and quantification of severe carotid stenoses, when compared with DSA. Severe ICA stenoses were diagnosed by US in a set of 29 patients. All patients also underwent CTA and DSA. Sensitivity, specificity, positive (PPV), negative predictive values (NPV), and Pearson's correlation coefficient were used in the evaluation of the percentage of stenosis results. Homogeneity chi2 test was applied when assessing statistical significance. Severe stenosis was diagnosed in 34 ICAs. Two ICAs with uninterpretable CTA finding were excluded. The number of ICAs with stenoses 70-99%/<70%- US 32/0; CTA 29/3; US + CTA 29/3; DSA 24/8. Pearson's correlation coefficient - US 0.601; CTA 0.725; US + CTA 0.773. Sensitivity/specificity/PPV/NPV - US 1.0/0.75/0.75/xxx; CTA 1.0/0.844/0.828/1.0; US + CTA 1.0/0.844/0.828/1.0. Homogeneity chi2 test results - US, P = 0.002; CTA, P = 0.098; US + CTAG, P = 0.098. US in combination with CTA can be used for relatively secure diagnostics of severe ICA stenoses. Thus, invasive DSA can be avoided in a substantial number of patients.
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Affiliation(s)
- R Herzig
- Neurosonological Laboratory, Stroke Center, Department of Neurology, University Hospital, Olomouc, Czech Republic.
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Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351:1493-501. [PMID: 15470212 DOI: 10.1056/nejmoa040127] [Citation(s) in RCA: 1847] [Impact Index Per Article: 92.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Carotid endarterectomy is more effective than medical management in the prevention of stroke in patients with severe symptomatic or asymptomatic atherosclerotic carotid-artery stenosis. Stenting with the use of an emboli-protection device is a less invasive revascularization strategy than endarterectomy in carotid-artery disease. METHODS We conducted a randomized trial comparing carotid-artery stenting with the use of an emboli-protection device to endarterectomy in 334 patients with coexisting conditions that potentially increased the risk posed by endarterectomy and who had either a symptomatic carotid-artery stenosis of at least 50 percent of the luminal diameter or an asymptomatic stenosis of at least 80 percent. The primary end point of the study was the cumulative incidence of a major cardiovascular event at 1 year--a composite of death, stroke, or myocardial infarction within 30 days after the intervention or death or ipsilateral stroke between 31 days and 1 year. The study was designed to test the hypothesis that the less invasive strategy, stenting, was not inferior to endarterectomy. RESULTS The primary end point occurred in 20 patients randomly assigned to undergo carotid-artery stenting with an emboli-protection device (cumulative incidence, 12.2 percent) and in 32 patients randomly assigned to undergo endarterectomy (cumulative incidence, 20.1 percent; absolute difference, -7.9 percentage points; 95 percent confidence interval, -16.4 to 0.7 percentage points; P=0.004 for noninferiority, and P=0.053 for superiority). At one year, carotid revascularization was repeated in fewer patients who had received stents than in those who had undergone endarterectomy (cumulative incidence, 0.6 percent vs. 4.3 percent; P=0.04). CONCLUSIONS Among patients with severe carotid-artery stenosis and coexisting conditions, carotid stenting with the use of an emboli-protection device is not inferior to carotid endarterectomy.
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Affiliation(s)
- Jay S Yadav
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Flemming KD, Brown RD, Petty GW, Huston J, Kallmes DF, Piepgras DG. Evaluation and management of transient ischemic attack and minor cerebral infarction. Mayo Clin Proc 2004; 79:1071-86. [PMID: 15301338 DOI: 10.4065/79.8.1071] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
After immediate intervention for cerebral infarction or transient ischemic attack (TIA), the primary goal is secondary prevention of future cerebral ischemia and prevention of complications related to the initial ischemic event. The goals of the diagnostic evaluation are to (1) determine potential contributing mechanisms (cardioembolic, large-vessel disease of the extracranial and intracranial vessels, small-vessel disease, coagulation defects, and cryptogenic), (2) identify contributing risk factors (hypertension, hyperlipidemia, tobacco use, diabetes), and (3) complete the evaluation in a cost-effective and safe manner. We provide a sequential approach to the diagnostic evaluation of cerebral infarction or TIA to optimize diagnostic yield of testing, minimize cost and potential harm to the patient, and provide information that will change management. This systematic approach focuses on 6 important questions: (1) Are the symptoms consistent with a cerebral infarction or TIA (versus nonischemic pathology)? (2) Where does the ischemic event localize? (3) What etiologies and mechanisms of cerebral infarction and TIA are possible? (4) What is the prevalence of each potential etiology? (5) What treatments are available for this etiology? (6) What tests and studies are useful to evaluate this etiology?
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Affiliation(s)
- Kelly D Flemming
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Brown OW, Bendick PJ, Bove PG, Long GW, Cornelius P, Zelenock GB, Shanley CJ. Reliability of extracranial carotid artery duplex ultrasound scanning: value of vascular laboratory accreditation. J Vasc Surg 2004; 39:366-71; discussion 371. [PMID: 14743137 DOI: 10.1016/j.jvs.2003.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the reliability of carotid duplex ultrasound scanning performed by nonaccredited vascular laboratories and to assess the clinical effect on patient management. METHODS We retrospectively reviewed concordance of findings of carotid duplex ultrasound scanning between laboratories accredited by the Intersocietal Commission for Accreditation of Vascular Laboratories and nonaccredited laboratories in 174 patients with asymptomatic disease referred to tertiary care community hospitals for surgical evaluation for carotid endarterectomy (CEA) between January 2001 and December 2002, and evaluated changes in clinical management made on the basis of repeat examinations. RESULTS Concordant findings were noted in 171 of 348 arteries (49%), predominantly those with minimal or mild disease (114 arteries; 67%). Discordant findings of no clinical significance were found in 54 arteries (16%). Clinically significant discordant findings were noted in 123 arteries (35%) in 107 patients (61%). In 104 arteries (88 patients) stenosis was overestimated by the nonaccredited laboratory secondary to technical error (19 arteries), use of B-mode imaging data alone (36 arteries), and use of inappropriate velocity criteria (49 arteries). None of these patients underwent CEA. Stenosis was significantly underestimated in 19 arteries (19 patients); all of these patients underwent uncomplicated CEA. CONCLUSIONS Incorrect physician interpretation of data is the most common cause of error in carotid duplex ultrasound scanning performed in nonaccredited vascular laboratories. Results of carotid duplex ultrasound scanning from nonaccredited laboratories should be considered with extreme caution, and do not appear reliable in planning treatment of obstructive disease.
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Affiliation(s)
- O William Brown
- Department of Surgery, William Beaumont Hospital, Royal Oak, MI 48037, USA.
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Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katarick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler E. Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis--Society of Radiologists in Ultrasound consensus conference. Ultrasound Q 2004; 19:190-8. [PMID: 14730262 DOI: 10.1097/00013644-200312000-00005] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel's consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists' experience. Key elements of the statement include the following: First, all internal carotid artery (ICA) examinations should be performed with grayscale, color Doppler, and spectral Doppler US. Second, the degree of stenosis determined at grayscale and Doppler US should be stratified into the categories of normal (no stenosis), less than 50% stenosis, 50 to 69% stenosis, > or =70% stenosis to near occlusion, near occlusion, and total occlusion. Third, ICA peak systolic velocity (PSV) and the presence of plaque on grayscale and/or color Doppler images are primarily used in the diagnosis and grading of ICA stenosis. Two additional parameters (the ICA-to-common carotid artery PSV ratio and ICA end diastolic velocity) may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. Fourth, ICA should be diagnosed as normal when ICA PSV is less than 125 cm/second and no plaque or intimal thickening is visible, less than 50% stenosis when ICA PSV is less than 125 cm/second and plaque or intimal thickening is visible, 50 to 69% stenosis when ICA PSV is 125 to 230 cm/second and plaque is visible, > or =70% stenosis to near occlusion when ICA PSV is more than 230 cm/second and visible plaque and lumen narrowing are seen, near occlusion when there is a markedly narrowed lumen on color Doppler US, and total occlusion when there is no detectable patent lumen on grayscale US and no flow on spectral, power, and color Doppler US. Fifth, the final report should discuss velocity measurements and grayscale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in these categories. The panel also considered various technical aspects of carotid US and methods for quality assessment, and identified several important unanswered questions meriting future research.
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Affiliation(s)
- Edward G Grant
- Department of Radiology, University of Southern California (USC), Keck School of Medicine, USC University Hospital, Los Angeles, CA 90033, USA.
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44
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Hwang CS, Liao KM, Tegeler CH. A Multiple Regression Model of Combined Duplex Criteria for Detecting Threshold Carotid Stenosis and Predicting the Exact Degree of Carotid Stenosis. J Neuroimaging 2003. [DOI: 10.1111/j.1552-6569.2003.tb00199.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Cinat ME, Casalme C, Wilson SE, Pham H, Anderson P. Computed Tomography Angiography Validates Duplex Sonographic Evaluation of Carotid Artery Stenosis. Am Surg 2003. [DOI: 10.1177/000313480306901005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Controversy regarding the optimal preoperative evaluation for patients with carotid arterial stenosis remains controversial. We hypothesized that carotid artery area reduction measured by computed tomography angiography (CTA) would closely correlate with duplex scanning stenosis. This study was undertaken to evaluate the correlation between duplex, CTA, and conventional arteriography in patients undergoing consideration for carotid endarterectomy. Patients undergoing evaluation for carotid artery stenosis who received at least 2 of the diagnostic tests were included in this study (n = 108); 30 patients underwent all 3 imaging modalities. Linear regression analysis was performed to determine correlation coefficients between the 3 different study modalities. Correlation and P values were as follows: CTA area versus CTA diameter, r = 0.82, P < 0.001; CTA area versus duplex stenosis, r = 0.71, P < 0.001; duplex stenosis versus angio diameter, r = 0.68; P = 0.005; CTA diameter versus angio diameter, r = 0.61, P = 005. CTA was able to identify plaque characteristics more readily than duplex or arteriography. CTA was also able to differentiate critical stenosis from occlusion and to settle discrepancies obtained from duplex scanning. CTA is an acceptable alternative method to validate duplex scanning evaluation of carotid artery stenosis. It can accurately measure lumen stenosis, visualize plaque morphology, and is associated with fewer complications than conventional angiography.
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Affiliation(s)
- Marianne E. Cinat
- University of California Irvine Medical Center, Orange, California, and the Long Beach Veterans Administration Medical Center, Long Beach, California
| | - Christine Casalme
- University of California Irvine Medical Center, Orange, California, and the Long Beach Veterans Administration Medical Center, Long Beach, California
| | - Samuel E. Wilson
- University of California Irvine Medical Center, Orange, California, and the Long Beach Veterans Administration Medical Center, Long Beach, California
| | - Hahn Pham
- University of California Irvine Medical Center, Orange, California, and the Long Beach Veterans Administration Medical Center, Long Beach, California
| | - Patrice Anderson
- University of California Irvine Medical Center, Orange, California, and the Long Beach Veterans Administration Medical Center, Long Beach, California
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Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katanick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler RE. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003; 229:340-6. [PMID: 14500855 DOI: 10.1148/radiol.2292030516] [Citation(s) in RCA: 892] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel's consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists' experience. Key elements of the statement include the following: (a) All internal carotid artery (ICA) examinations should be performed with gray-scale, color Doppler, and spectral Doppler US. (b) The degree of stenosis determined at gray-scale and Doppler US should be stratified into the categories of normal (no stenosis), <50% stenosis, 50%-69% stenosis, > or =70% stenosis to near occlusion, near occlusion, and total occlusion. (c) ICA peak systolic velocity (PSV) and presence of plaque on gray-scale and/or color Doppler images are primarily used in diagnosis and grading of ICA stenosis; two additional parameters, ICA-to-common carotid artery PSV ratio and ICA end-diastolic velocity may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. (d) ICA should be diagnosed as (i) normal when ICA PSV is less than 125 cm/sec and no plaque or intimal thickening is visible; (ii) <50% stenosis when ICA PSV is less than 125 cm/sec and plaque or intimal thickening is visible; (iii) 50%-69% stenosis when ICA PSV is 125-230 cm/sec and plaque is visible; (iv) > or =70% stenosis to near occlusion when ICA PSV is greater than 230 cm/sec and visible plaque and lumen narrowing are seen; (v) near occlusion when there is a markedly narrowed lumen at color Doppler US; and (vi) total occlusion when there is no detectable patent lumen at gray-scale US and no flow at spectral, power, and color Doppler US. (e) The final report should discuss velocity measurements and gray-scale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in the above categories. The panel also considered various technical aspects of carotid US and methods for quality assessment and identified several important unanswered questions meriting future research.
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Affiliation(s)
- Edward G Grant
- Department of Radiology, University of Southern California, Keck School of Medicine, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033, USA.
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Nederkoorn PJ, van der Graaf Y, Hunink MGM. Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke 2003; 34:1324-32. [PMID: 12690221 DOI: 10.1161/01.str.0000068367.08991.a2] [Citation(s) in RCA: 287] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this work was to review and compare published data on the diagnostic value of duplex ultrasonography (DUS), MR angiography (MRA), and conventional digital subtraction angiography (DSA) for the diagnosis of carotid artery stenosis. METHODS We performed a systematic review of published studies retrieved through PUBMED, from bibliographies of review papers, and from experts. The English-language medical literature was searched for studies that met the selection criteria: (1) The study was published between 1994 and 2001; (2) MRA and/or DUS was performed to estimate the severity of carotid artery stenosis; (3) DSA was used as the standard of reference; and (4) the absolute numbers of true positives, false negatives, true negatives, and false positives were available or derivable for at least one definition of disease (degree of stenosis). RESULTS Sixty-three publications on duplex, MRA, or both were included in the analysis, yielding the test results of 64 different patient series on DUS and 21 on MRA. For the diagnosis of 70% to 99% versus <70% stenosis, MRA had a pooled sensitivity of 95% (95% CI, 92 to 97) and a pooled specificity of 90% (95% CI, 86 to 93). These numbers were 86% (95% CI, 84 to 89) and 87% (95% CI, 84 to 90) for DUS, respectively. For recognizing occlusion, MRA yielded a sensitivity of 98% (95% CI, 94 to 100) and a specificity of 100% (95% CI, 99 to 100), and DUS had a sensitivity of 96% (95% CI, 94 to 98) and a specificity of 100% (95% CI, 99 to 100). A multivariable summary receiver-operating characteristic curve (ROC) analysis for diagnosing 70% to 99% stenosis demonstrated that the type of MR scanner predicted the performance of MRA, whereas the presence of verification bias predicted the performance of DUS. For diagnosing occlusion, no significant heterogeneity was found for MRA; for DUS, the presence of verification bias and type of DUS scanner were explanatory variables. MRA had a significantly better discriminatory power than DUS in diagnosing 70% to 99% stenosis (regression coefficient, 1.6; 95% CI, 0.37 to 2.77). No significant difference was found in detecting occlusion (regression coefficient, 0.73; 95% CI, -2.06 to 3.51). CONCLUSIONS These results suggest that MRA has a better discriminatory power compared with DUS in diagnosing 70% to 99% stenosis and is a sensitive and specific test compared with DSA in the evaluation of carotid artery stenosis. For detecting occlusion, both DUS and MRA are very accurate.
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Affiliation(s)
- Paul J Nederkoorn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Hwang CS, Liao KM, Lee JH, Tegeler CH. Measurement of Carotid Stenosis: Comparisons Between Duplex and Different Angiographic Grading Methods. J Neuroimaging 2003. [DOI: 10.1111/j.1552-6569.2003.tb00169.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Poepping TL, Gill J, Fenster A, Holdsworth DW. MP3 compression of Doppler ultrasound signals. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:65-76. [PMID: 12604118 DOI: 10.1016/s0301-5629(02)00696-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The effect of lossy, MP3 compression on spectral parameters derived from Doppler ultrasound (US) signals was investigated. Compression was tested on signals acquired from two sources: 1. phase quadrature and 2. stereo audio directional output. A total of 11, 10-s acquisitions of Doppler US signal were collected from each source at three sites in a flow phantom. Doppler signals were digitized at 44.1 kHz and compressed using four grades of MP3 compression (in kilobits per second, kbps; compression ratios in brackets): 1400 kbps (uncompressed), 128 kbps (11:1), 64 kbps (22:1) and 32 kbps (44:1). Doppler spectra were characterized by peak velocity, mean velocity, spectral width, integrated power and ratio of spectral power between negative and positive velocities. The results suggest that MP3 compression on digital Doppler US signals is feasible at 128 kbps, with a resulting 11:1 compression ratio, without compromising clinically relevant information. Higher compression ratios led to significant differences for both signal sources when compared with the uncompressed signals.
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Abstract
Medical treatment for carotid disease is similar to the treatment of atherosclerosis, with some recent data suggesting that there is a benefit to an aspirin-dipyridamole combination. CEA has revolutionized the treatment of symptomatic and asymptomatic carotid stenosis. This approach remains the gold standard for the surgical treatment of carotid artery stenosis, against which emerging modalities such as percutaneous carotid stenting should be compared. Higher-risk, asymptomatic patients can safely undergo CEA in high-volume centers for stenosis greater than 80% as defined by ultrasound.
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Affiliation(s)
- Gorav Ailawadi
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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