title: Dolichocarotids: echo-color Doppler evaluation and clinical role.
abstract: OBJECTIVE
  Dolichocarotids(DCs) represent a rare(2-6%) carotid imaging finding in the general population that may be free of clinical significance or be associated with cerebrovascular events. Their detection is traditionally assigned to carotid echo-color Doppler(ECD) and selective angiography(the standard method). The primary aim of this study was to estimate the sensitivity, specificity and accuracy of ECD in detecting DCs. Moreover, we monitored the DC curvature angle and the incidence of TIA, ischemic stroke, myocardial infarction and cardiovascular death over a five-year followup period.
  
  
  METHODS
  A total of 112 consecutive patients with DCs(80 men, mean age: 61±7 years) were recruited for carotid ECD and carotid angiography due to the persistence of neurological symptoms not well explained on ultrasound evaluations, according to the current guidelines.
  
  
  RESULTS
  ECD proved to have 100% sensitivity in detecting tortuosity and coiling and 96% sensitivity in detecting kinking, with an overall accuracy ranging from 92% to 100%. The specificity was 75% for tortuosity, 91% for kinking and 100% for coiling. During the five-year follow-up period, there was a statistically significant increase in tortuosity(61±11° at baseline versus 81±11° after five years, p＜0.001) and the kinking curvature angle(97±3° at baseline versus 100±3° at five years, p＜0.001), whilst no differences were observed with respect to coiling(136±10° at baseline versus 138±11° at five years, p=ns). Moreover, kinking was found to be more frequently statistically associated with cardiovascular death than tortuosity(p=0.005).
  
  
  CONCLUSIONS
  DCs predispose patients to potentially disabling and fatal events. ECD plays a primary role in the detection of DCs and therefore should be considered to be a secure and reproducible technique.
authors.affiliation: Cardiology Unit, Emergency and Organ Transplantation Department(DETO), University of Bari.
authors.forename: Marco
authors.initials: M
authors.lastname: Matteo Ciccone
authors.forename: Rakesh
authors.initials: R
authors.lastname: K Sharma
authors.forename: Pietro
authors.initials: P
authors.lastname: Scicchitano
authors.forename: Francesca
authors.initials: F
authors.lastname: Cortese
authors.forename: Christian
authors.initials: C
authors.lastname: Salerno
authors.forename: Paola
authors.initials: P
authors.lastname: Berchialla
authors.forename: Giulia
authors.initials: G
authors.lastname: Frasso
authors.forename: Marco
authors.initials: M
authors.lastname: Sassara
authors.forename: Mariangela
authors.initials: M
authors.lastname: Carbone
authors.forename: Pasquale
authors.initials: P
authors.lastname: Palmiero
authors.forename: Maria
authors.initials: M
authors.lastname: Maiello
authors.forename: Donald
authors.initials: D
authors.lastname: J Voelker
authors.forename: Hanumanth
authors.initials: H
authors.lastname: K Reddy
authors.forename: Francesco
authors.initials: F
authors.lastname: Federico
mesh_terms: D002339:Carotid Arteries / Q000002:abnormalities*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D017023:Coronary Angiography; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015996:Survival Rate; D018615:Ultrasonography, Doppler, Color / Q000379:methods*