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10 - Conventional digital subtraction angiography for carotid disease

from Luminal imaging techniques

Published online by Cambridge University Press:  03 December 2009

Jean Marie U-King-Im
Affiliation:
Addenbrooke's Hospital and the University of Cambridge, UK
Jonathan H. Gillard
Affiliation:
Addenbrooke's Hospital and the University of Cambridge, UK
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
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Summary

Introduction

Carotid endarterectomy is now one of the most commonly performed vascular operations in the Western world, with significant increases in rates since the publication of large randomized trials such as the North American symptomatic carotid endarterectomy trial (NASCET) and the European carotid surgery trial [ECST], which have clearly demonstrated the benefits of surgery over medical therapy in recently symptomatic patients with severe carotid stenosis (randomized trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European carotid surgery trial (ECST), 1998; Barnett et al., 1998; Tu et al., 1998). In these trials, risk stratification was mainly based on severity of luminal stenosis and this has naturally highlighted the importance of accurate carotid imaging for patient selection. The gold standard method, in terms of diagnostic accuracy, for the measurement of stenosis remains conventional digital subtraction angiography (DSA), which was in routine use at the time of these trials. There are, however, several disadvantages associated with DSA. It is a relatively expensive and labor-intensive procedure whose costs may be up to 2.4 times that of alternative procedures such as magnetic resonance angiography (MRA) (U-King-Im et al., 2004a). Moreover, patients, if given the choice, may tend to prefer less invasive modalities such as MRA (U. King-Im et al., 2004c).

Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
, pp. 126 - 139
Publisher: Cambridge University Press
Print publication year: 2006

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