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12 - Computed tomographic angiography of carotid artery stenosis

from Luminal imaging techniques

Published online by Cambridge University Press:  03 December 2009

By
Paul J. Nederkoorn ,
Charles B. L. M. Majoie  and
Jan Stam
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Paul J. Nederkoorn
Affiliation:
Academic Medical Center, Amsterdam, The Netherlands
Charles B. L. M. Majoie
Affiliation:
Academic Medical Center, Amsterdam, The Netherlands
Jan Stam
Affiliation:
Academic Medical Center, Amsterdam, The Netherlands
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
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Summary

Introduction

In large randomized trials carotid endarterectomy was shown to be beneficial in symptomatic patients (transient ischemic attack [TIA] or minor stroke in the past 6 months) with a severe stenosis (70–99%) of the internal carotid artery (ICA) (Rothwell et al., 2003). Subgroups of patients with a symptomatic stenosis of 50–69% also benefit from carotid endarterectomy. Recently, even for asymptomatic patients, a small effect of carotid endarterectomy was reported (Halliday et al., 2004). The discussion whether this effect was sufficiently large to advise surgery to (subgroups of) asymptomatic patients is still ongoing (Barnett, 2004). A more recent development is treatment of the carotid artery stenosis with endovascular stenting (Cambria, 2004). Randomized trials are still ongoing to assess the efficacy of this treatment. In the trials with symptomatic patients, an increasing degree of stenosis yielded increasing benefit from surgery. Therefore, precise estimation of the degree of stenosis is crucial for decisions on interventions for carotid artery atherosclerotic disease.

In the trials the degree of stenosis was assessed with intraarterial digital subtraction angiography (DSA), which consequently has become the standard of reference in the selection of patients for carotid endarterectomy. However, DSA has a nonnegligible morbidity and mortality, which decreases the potential overall benefit of endarterectomy (Hankey et al., 1990; Willinsky et al., 2003).

Keywords

carotid artery stenosiscomputerized tomography angiographydiagnostic accuracylumenpost processing techniquesmagnetic resonance angiography
Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 158 - 165
Publisher: Cambridge University Press
Print publication year: 2006

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