This paper is only available as a PDF. To read, Please Download here.
Abstract
Background. This report describes our experience with the use of duplex imaging and magnetic
resonance angiography (MRA) in the diagnosis and management of 70 patients with symptomatic
carotid artery disease. Prospective evaluation of our first 30 patients showed that
duplex imaging and MRA accurately correlated with conventional cerebral arteriograms
(XRA) in patients with symptoms with greater than 70% ipsilateral carotid artery stenoses.
In MRA versus XRA accuracy was 94%, sensitivity 100%, and specificity 93%. With duplex
scanning versus XRA accuracy was 88%, sensitivity 93%, and specificity 93%.
Methods. We are now performing carotid endarterectomy on patients with symptoms without preoperative
XRA when there is exact correlation between duplex imaging and MRA. Patients must
have focal hemispheric symptoms, ipsilateral duplex peak systolic velocity greater
than 2 m/sec, and high-quality MRA imaging of the carotid vessels.
Results. We have prospectively entered 40 patients for preoperative evaluation with duplex
imaging and MRA. High-quality MRA and duplex studies were obtained in 35 patients
(88%). XRA was required in the remaining five patients (12%) because of discrepancies
between duplex scanning and MRA. Endarterectomy was performed without morbidity or
death. Combined use of duplex scanning and MRA eliminated XRA in 35 cases and created
a net savings of more than $125,000.
Conclusions. Our experience suggests that preoperative XRA may not be necessary when duplex imaging
and MRA confirm the presence of severe extracranial disease.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Magnetic resonance angiography and stroke: techniques, applications, and limitations.Stroke. 1992; 2: 509-531
- Stenosis of the internal carotid artery: assessment using color Doppler imaging compared with angiography.AJR. 1989; 152: 1299-1305
- Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med. 1992; 325: 445-453
- MRC European carotid Surgery trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis.Lancet. 1992; 337: 1235-1243
- Carotid artery: prospective blinded comparison of two-dimensional time-of-flight MR angiography with conventional angiography and duplex US.Radiology. 1993; 186: 339-344
- Standards in noninvasive cerebrovascular testing.J Vasc Surg. 1992; 15: 495-503
- Can carotid duplex scanning supplant arteriography in patients with focal carotid territory symptoms?.J Vasc Surg. 1987; 5: 551-557
- Is routine angiography necessary prior to carotid endarterectomy?.J Vasc Surg. 1984; 1: 96-102
- Carotid endarterectomy: practice guidelines.J Vasc Surg. 1992; 15: 469-479
- Noninvasive carotid evaluation: carpe diem.Radiology. 1993; 186: 329-331
- Carotid endarterectomy: preoperative evaluation of candidates with combined Doppler sonography and MR angiography.Radiology. 1993; 186: 333-338
- Comparison of magnetic resonance angiography, conventional angiography, and duplex scanning.Stroke. 1992; 23: 341-346
- Noninvasive carotid imaging: caveat emptor.Radiology. 1993; 186: 325-331
Article info
Footnotes
☆Presented at the Fiftieth Annual Meeting of the Central Surgical Association, Cincinnati, Ohio, March 4–6, 1993.
Identification
Copyright
© 1993 Published by Elsevier Inc.
