[Recommendations by the Swedish Quality Board for Carotid Surgery. Ultrasound good preoperative method for evaluating degree of carotid stenosis].
The estimated degree of carotid stenosis is decisive for the selection of patients who would benefit from surgical treatment. Carotid thrombendarterectomy is recommended in patients with symptomatic > or = 80 procent internal carotid artery stenosis (ECST method). Many vascular centers now often rely entirely on duplex ultrasonography to select the patients for carotid surgery. The results of a recently published Swedish multicenter study (Jogestrand et al., Eur J Vasc Endovasc Surg 2002; 23:510-8) demonstrate that certain technical aspects of the ultrasound examination are of importance for the estimation of the degree of stenosis. Based on these results, the Swedish Quality Board for Carotid Surgery recommends the use of Doppler angle range specific cut off points for the peak systolic velocity in the internal carotid artery for identification of high-grade internal carotid artery stenosis: These cut off points are > or = 2.1 m/s for insonation angles of 0-49 degrees and > or = 3.2 m/s for angles 50-60 degrees. The angle of insonation should be kept as small as possible and should always be stated in the investigators report.
Jogestrand
Tomas
T
Fysiologkliniken, Huddinge Universitetssjukhus. tomas.jogestrand@labmed.ki.se
von Arbin
Magnus
M
Bergqvist
David
D
Lilja
Anders
A
Lindqvist
Melker
M
Mätzsch
Thomas
T
Norrving
Bo
B
Nowak
Jacek
J
Troëng
Thomas
T
Wahlgren
Nils Gunnar
NG
D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D003657:Decision Making; D016894:Endarterectomy, Carotid / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012016:Reference Values; D013548:Sweden; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*