Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American Symptomatic Carotid Endarterectomy.

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Presentation transcript:

Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial Michael L. Neale, MBBS, Jennifer L. Chambers, MBBS, FRACS, Alison T. Kelly, RN, RVT, DMU, Suzanne Connard, DMU, Margaret A. Lawton, BSc, James Roche, FRACR, Michael Appleberg, FCS(SA), FRACS, FACS, DDU Journal of Vascular Surgery Volume 20, Issue 4, Pages 642-649 (October 1994) DOI: 10.1016/0741-5214(94)90290-9 Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Measurement of internal carotid artery stenosis on angiograms. In method 1 (as in NASCET), percent stenosis = (1 – a/c) x 100 (i.e., ratio of residual lumen to normal distal internal carotid artery). In method 2 (as in ECST), percent stenosis = (1 – a/b) x 100 (i.e., ratio of residual lumen to estimated normal bulb diameter). Journal of Vascular Surgery 1994 20, 642-649DOI: (10.1016/0741-5214(94)90290-9) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Graph of sensitivity and specificity of duplex scanning in identifying angiographic stenosis of greater than 70% based on peak systolic velocity. Line at peak systolic velocity = 270 cm/sec shows sensitivity of 96% and specificity of 86%. Above this, significant loss of sensitivity with little gain in specificity is seen. Journal of Vascular Surgery 1994 20, 642-649DOI: (10.1016/0741-5214(94)90290-9) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Graph of sensitivity and specificity of duplex scanning in identifying an angiographic stenosis of greater than 70% based on end diastolic velocity. Line at end diastolic velocity = 110 cm/sec shows sensitivity of 91% and specificity of 93%. Above this, significant loss of sensitivity with little gain in specificity is seen. Journal of Vascular Surgery 1994 20, 642-649DOI: (10.1016/0741-5214(94)90290-9) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions