Document Detail


Carotid duplex overestimation of stenosis due to severe contralateral disease.
MedLine Citation:
PMID:  8795517     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In the quest to use carotid duplex to assess carotid occlusive disease, it has been reported that the current velocity criteria to calculate stenosis tends to overestimate the severity when there is a contralateral highly stenotic or occluded carotid artery. METHODS: Patient records were reviewed for 592 consecutive carotid endarterectomies performed from 1987 to 1994. Preoperative and postoperative duplex scan results were compared in a subset of patients in whom duplex overestimated the degree of stenosis, as compared to preoperative angiography. RESULTS: A total of 146 patients were identified in whom duplex overestimated the degree of stenosis contralateral to a high grade stenosis or an occlusion. Of 76 arteries, 18 (23.7%) contralateral to an occluded artery were overestimated by duplex, and 128 (27.0%) of 474 arteries contralateral to a high grade stenosis were overestimated. Following endarterectomy 44 (51.8%) of 128 nonoperated contralateral stenoses decreased by at least one duplex category. The average peak systolic frequency (PSF) decreased by 1175 Hz (P = 0.0018), and the average end diastolic frequency (EDF) decreased by 475 Hz (P = 0.011). CONCLUSIONS: Patients with high grade stenosis have a significant decrease in PSF and EDF in the unoperated carotid after endarterectomy, supporting a compensatory flow phenomenon. This often results in a decrease in the postoperative duplex defined stenosis by at least one category. The clinical significance of these findings is of increasing importance as carotid surgery is being performed more frequently without angiography.
Authors:
S J Busuttil; D P Franklin; J R Youkey; J R Elmore
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  172     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1996-10-15     Completed Date:  1996-10-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  144-7; discussion 147-8     Citation Subset:  AIM; IM    
Affiliation:
Section of Vascular Surgery, Geisinger Clinic, Danville, Pennsylvania 17822-1343, USA.
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MeSH Terms
Descriptor/Qualifier:
Angiography
Blood Flow Velocity
Carotid Stenosis / radiography,  surgery,  ultrasonography*
Endarterectomy, Carotid
Humans
Linear Models
Medical Records
Predictive Value of Tests
Retrospective Studies
Severity of Illness Index
Ultrasonography, Doppler, Duplex*

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


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