Optimising the use of carotid duplex sonography.
OBJECTIVE
We analysed factors influencing diagnostic yield and treatment and their potential for optimising the use of carotid duplex sonography (CDS).


METHODS
Patients referred for CDS were divided into three groups: 1: high likelihood of carotid symptoms, 2: suspected presence of asymptomatic carotid lesions, 3: other indications. Clinical data, the grading of stenosis and the therapeutic consequences were analysed. The efficiency of diagnosis was tested with an algorithm.


RESULTS
344 patients were included. Groups 1, 2 and 3 contained > or = 1 pathological finding in the carotid or vertebral system in 68%, 86% and 55% respectively, whereas high-grade stenoses or occlusions of the internal carotid artery (ICA) were detected in 10.8%, 16% and 3.6% respectively. Age > 50, > 1 risk factor, carotid murmur and concomitant vascular disease were associated with a significantly higher diagnostic yield. Subsequent treatment in groups 1, 2 and 3 involved carotid thromboendarterectomy in 6.4%, 2% and 0.7% respectively and the start of treatment with a platelet aggregation inhibitor in 9%, 30% and 17% respectively. The optimisation algorithm would have saved 21% of CDS scans.


CONCLUSIONS
Clinical pre-selection criteria determine the diagnostic yield of CDS. The potential for optimisation depends on the treatment regimen chosen for asymptomatic stenoses and secondary prophylaxis.
Frauchiger
B
B
Department of Internal Medicine, Division of Angiology, Kantonsspital, Frauenfeld, Switzerland. beat.frauchiger@kttg.ch
Nussbaumer
P
P
Roedel
C
C
Magun
J G
JG
Oehy
K
K
Staub
D
D
D000367:Age Factors; D000465:Algorithms; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000502:physiology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012737:Sex Factors; D018709:Statistics, Nonparametric; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*