Document Detail

Carotid endarterectomy without angiography: is color-flow duplex scanning sufficient?
MedLine Citation:
PMID:  7940178     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: This study was designed to determine whether clinical evaluation and color-flow duplex scanning (CFS) alone provide enough information for patients to undergo carotid endarterectomy (CEA) safely without preoperative cerebral angiography and to assess the appropriate role of CFS in the evaluation of extracranial carotid artery disease. METHODS: During a 31-month period 167 patients (114 symptomatic and 53 asymptomatic) underwent CFS and angiography during evaluation for CEA. One hundred fifty-three patients were studied retrospectively, and 14 were studied prospectively. Data were reviewed to determine whether cerebral angiography added information not provided by duplex findings and, if so, did the results alter clinical management. RESULTS: Of the 167 patients studied, 149 underwent CEA and 18 were treated medically. Results of the two diagnostic modalities agreed perfectly in 82% of the patients, with 99% of the stenoses estimated by CFS being classified within one category of those measured with angiography. The sensitivity of CFS for detecting greater than 50% diameter-reducing stenoses of the internal carotid artery was 98%, and the positive predictive value was 99%. For detecting greater than 80% stenoses, CFS had a sensitivity of 84% and a positive predictive value of 95%. Clinical management was altered by angiographic findings in only seven patients (4%). False-positive results (n = 5) were due to poor scanning technique or interpreter error (n = 2), anatomic variations (n = 2), and unknown cause (n = 1). All false-negative results (n = 2) were due to poor scanning technique. CONCLUSIONS: Ninety-six percent of the patients in this study would have received appropriate clinical management based on neurologic history and the results of CFS alone. Our results indicate that CFS is sufficient for determining the need for surgery in patients being considered for CEA and can supplant cerebral angiography in nearly all clinical circumstances.
M A Mattos; K J Hodgson; W E Faught; A Mansour; L D Barkmeier; D E Ramsey; D S Sumner
Related Documents :
16542168 - Flow-mediated dilatation and intima-media thickness in patients with lacunar infarctions.
21939848 - Seizure prediction and its applications.
9814678 - Detection of cerebral microemboli in aps--introducing a novel investigation method and ...
6850258 - The influence of ultrasonic duplex scanning on the management of carotid artery disease.
22244918 - High frequency of human leukocyte antigen class ii drb1*1602 haplotype in greek patient...
19926748 - Prevalence and clinical correlates of bronchoreversibility in severe emphysema.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  116     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1994 Oct 
Date Detail:
Created Date:  1994-11-16     Completed Date:  1994-11-16     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  776-82; discussion 782-3     Citation Subset:  AIM; IM    
Southern Illinois University School of Medicine, Department of Surgery, Springfield 62794-9230.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Aged, 80 and over
Carotid Stenosis / diagnosis*
Cerebral Angiography*
Endarterectomy, Carotid*
Middle Aged

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

Previous Document:  Surgical patients with pseudomembranous colitis: factors affecting prognosis.
Next Document:  Long-term effectiveness of extraanatomic renal artery revascularization.