Accuracy of duplex versus angiography in patients undergoing carotid surgery.
The operative findings of 23 carotid arteries were compared with pre-operative duplex scans and angiography. Both duplex and angiography had a high degree of accuracy in detecting haemodynamically significant lesions of 50-99% (88 and 92%, respectively). Their accuracy, however, in correctly predicting the grade of stenosis was significantly lower; 30 and 48%, respectively (P < 0.001). They each exhibited an accuracy of 70% and 78%, respectively, in the detection of ulceration. Overall, both duplex and angiography displayed an accuracy of 87% in indicating the proper management course. The combination of both investigations increased this accuracy to 94.6%. In severely stenotic lesions, duplex to rule out occlusion was not reliable. On statistical analysis, there was no difference between duplex and angiography in predicting haemodynamically significant lesions of 50-99%, estimating the grade of stenosis, the detection of ulceration, or indicating the proper management course. In most situations, duplex alone equalled the accuracy of angiography in the pre-operative assessment of patients for carotid surgery. For stenotic lesions of > 90%, however, we recommend supplemental angiography to rule out occlusion.
Boyle
M J
MJ
Department of Vascular Surgery, Wordsley Hospital, Stourbridge, West Midlands, UK.
Wolinski
A P
AP
Grimley
R P
RP
D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D002340:Carotid Artery Diseases / Q000601:surgery; D016893:Carotid Stenosis / Q000473:pathology; D006801:Humans; D011859:Radiography; D012680:Sensitivity and Specificity; D018616:Ultrasonography, Doppler, Duplex