Document Detail

Can simple clinical features be used to identify patients with severe carotid stenosis on Doppler ultrasound?
MedLine Citation:
PMID:  9886444     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Carotid endarterectomy reduces the risk of stroke in symptomatic patients with severe ipsilateral carotid stenosis. Symptomatic patients should therefore undergo carotid Doppler imaging, but in some centres access to imaging is limited. It was therefore investigated whether simple clinical features alone or in combination could be used to identify patients with severe carotid stenosis, so that they could be referred preferentially for carotid imaging. METHODS: 1041 patients with acute stroke, cerebral or retinal transient ischaemic attacks, and retinal strokes admitted to Western General Hospital or seen in neurovascular clinics were assessed by a stroke physician. Their carotid arteries were investigated using colour Doppler imaging by a consultant neuroradiologist. Patients with primary intracerebral haemorrhage, total anterior circulation strokes, posterior circulation strokes, or posterior circulation transient ischaemic attacks were excluded because carotid surgery would be inappropriate. RESULTS: 726 patients were used in the analysis. Stepwise logistic regression showed that there were significant positive associations between severe carotid stenosis and an ipsilateral bruit, diabetes mellitus, and previous transient ischaemic attacks; and a negative association with lacunar events. The strategy with the highest specificity (97%) was "any three of these four features" but sensitivity was only 17%. The strategy with the highest sensitivity (99%) was to use one or more of the four features, but specificity was only 22%. CONCLUSION: None of the strategies identified all patients with severe carotid stenosis with a reasonable specificity. When access to carotid imaging is severely limited, simple clinical features are of some use in prioritising patients for imaging, but access to carotid imaging should be improved.
G E Mead; J M Wardlaw; S C Lewis; M McDowall; M S Dennis
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  66     ISSN:  0022-3050     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-02-04     Completed Date:  1999-02-04     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  16-9     Citation Subset:  IM    
Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, UK.
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MeSH Terms
Brain / blood supply
Brain Ischemia / complications,  diagnosis
Carotid Stenosis / complications,  diagnosis*
Diabetes Complications
Diabetes Mellitus / diagnosis
Functional Laterality
Patient Selection
Retrospective Studies
Severity of Illness Index
Ultrasonography, Doppler, Color / methods*
Comment In:
J Neurol Neurosurg Psychiatry. 1999 Jan;66(1):4   [PMID:  9886442 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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