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Reliability of Carotid Doppler performed in a dedicated Stroke Prevention Clinic

  • N. Dean (a1), H. Lari (a1), M. Saqqur (a1), N. Amir (a1), K. Khan (a1), M. Mouradian (a1), Abdul Salam (a1), H. Romanchuk (a1) and A. Shuaib (a1)...

Abstract:

Introduction:

Doppler ultrasound (DUS) is used as a screening tool to assess internal carotid artery (ICA) disease. Recent reports suggest that the DUS may be inaccurate in over 28% of patients. We sought to evaluate the accuracy of DUS, when performed in a dedicated stroke prevention clinic (SPC).

Methods:

We retrospectively reviewed the charts of patients who had a DUS performed in our SPC, followed by conventional cerebral angiography. Three groups of patients were defined. Group 1 had DUS measured ICA stenosis of >50%; Group II had a DUS measured ICA stenosis of <50%; Group III had complete ICA occlusion on DUS.

Results:

Sixty-seven patients (69 arteries) were included in the study. There were 45 patients in Group I and based on the findings of cerebral angiography, carotid endarterectomy was considered inappropriate in only one patient. - a misclassification rate of 2.2% (95%CI: 0 – 6.5%). Group II consisted of 19 patients and on cerebral angiography, none of these patients had a stenosis of >50% - a misclassification rate of 0%. Group III consisted of five patients in whom DUS showed complete ICA occlusion. The angiogram confirmed the occlusion in all five patients – a misclassification rate of 0%. Overall, misclassification rate was 1.45% (95% CI: 0 - 4.3%).

Conclusions:

Doppler ultrasound when performed in a stroke prevention clinic (SPC), has a high accuracy in measuring ICA stenosis of >50%. Doppler ultrasound is reliable in detecting complete ICA occlusion and finally DUS is a reliable screening tool to rule out clinically significant ICA stenosis.

RÉSUMÉ: Introduction:

L’ultrasonographie Doppler (UD) est utilisée comme méthode de dépistage pour l’évaluation de la carotide interne (CI). Des études récentes suggèrent que l’UD serait inexacte chez plus de 28% des patients. Nous avons évalué l’exactitude de l’UD faite dans une clinique de prévention de l’accident vasculaire cérébral.

Méthodes:

Nous avons procédé à une revue rétrospective de dossiers de patients qui ont subi une UD à notre clinique, suivie d’une angiographie cérébrale conventionnelle. Les patients ont été répartis en trois groupes: à l’UD, le groupe 1 avait une sténose de la CI de plus de 50%, le groupe 2 avait une sténose de moins de 50% et le groupe 3 avait une occlusion complète de la CI.

Résultats:

Soixante-sept patients (69 artères) ont été inclus dans l’étude. Il y avait 45 patients dans le groupe 1 et, tenant compte des résultats de l’angiographie cérébrale, l’endartérectomie carotidienne était indiquée chez tous les patients sauf un, soit un taux de classification erronée de 2,2% (IC à 95% de 0 à 6,5%). À l’angiographie cérébrale, aucun des 19 patients du groupe 2 n’avait une sténose de plus de 50%, un taux de classification erronée de 0%. L’angiogramme a confirmé l’occlusion complète chez les 5 patients du groupe 3, un taux de classification erronée de 0%. Dans l’ensemble le taux de classification erronée était de 1,45% (IC à 95% de 0 à 4,3%)

Conclusions:

L’UD en clinique de prévention de l’accident vasculaire cérébral, a un haut degré d’exactitude pour mesurer une sténose de la CI de plus de 50%. L’UD est fiable pour détecter une occlusion complète de la CI et constitue également un outil de dépistage fiable pour exclure une sténose significative de la CI.

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Copyright

Corresponding author

Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, 2E3 Walter C. Mackenzie Health Sciences Centre, Edmonton, Alberta T6G 2B7 Canada

References

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1. NASCET, collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenosis. N Engl J Med 1991;325:445453.
2. Rofsky, NM, Adleman, MA. Gadoliniun enhanced MR angiography of the carotid arteries: a small step, a giant leap? Radiology 1998;209:3134.
3. Anderson, GB, Ashforth, R, Steinke, DE. CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke 2000;31:21682174.
4. Barnett, HJ, Broderick, JP. Carotid endarterectomy: another wake up call. Neurology 2000;55:746747.
5. Pryor, JC, Setton, A, Nelson, PK, Bernstein, A. Complications of diagnostic cerebral angiography and tips on avoidance. Neuroimaging Clin N Am 1996;6:751757.
6. Warnock, NG, Gandhi, MR, Bergvall, U, Powell, T. Complications of intra-arterial digital subtraction angiography in patients investigated for cerebrovascular disease. Br J Radiol 1993;66:855858.
7. Dawson, DL, Zierler, RE, Strandness, DE. The role of duplex scanning and arteriography before carotid endarterectomy: A prospective study. J Vasc Surg 1993;18:673683.
8. Johnston, DCC, Goldstein, LB. Clinical carotid endarterectomy decision making. Neurology 2001;56:10091015.
9. Taylor, DC, Strandness, DE. Carotid artery duplex scanning. J Clin Ultrasound 1987;15:635644.
10. Moneta, Gl, et al. Correlation of North American Symptomatic Carotid Endarterectomy Trial ( NASCET ) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning. J Vasc Surg 1993;17:152159.
11. Barnett, HJM, Taylor, DW, Eliasziw, M, et al. Benefit of carotid endarterectomy in patients with moderate or severe stenosis. N Engl J Med 1998;339:14151425.
12. Qureshi, AI, Suri, MFK, Ali, Z, et al. Role of conventional angiography in evaluation of patients with carotid artery stenosis demonstrated by Doppler ultrasound in general practice. Stroke 2001;32:22872291.
13. Bornstein, NM, Beloev, ZG, Norris, JW, The limitations of Diagnosis of carotid occlusion by Doppler Ultrasound. Ann Surg 1998: 207: 315317.
14. Zwiebel, WJ, Introduction to Vascular Technology. W.B. Saunders Company. Philadelphia, USA; 1992: 108, 115116, 129.
15. Labs, KH, Jager, KA, Fitzgerald, DE, Woodcock, JP, Neurberg-Heusler, D. Diagnostic Vascular Ultrasound. Edward Arnold 1992: 198.

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