Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-22T21:05:18.106Z Has data issue: false hasContentIssue false
  • English
  • Français

Reliability of Carotid Doppler performed in a dedicated Stroke Prevention Clinic

Published online by Cambridge University Press:  02 December 2014

N. Dean ,
H. Lari ,
M. Saqqur ,
N. Amir ,
K. Khan ,
M. Mouradian ,
Abdul Salam ,
H. Romanchuk  and
A. Shuaib
N. Dean
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
H. Lari
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
M. Saqqur
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
N. Amir
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
K. Khan
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
M. Mouradian
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
Abdul Salam
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
H. Romanchuk
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
A. Shuaib*
Affiliation:
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, Edmonton, Alberta, Canada
*
Division of Neurology, The Al Owen and Family Stroke Prevention Clinic, University of Alberta, 2E3 Walter C. Mackenzie Health Sciences Centre, Edmonton, Alberta T6G 2B7 Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction:

Doppler ultrasound (DUS) is used as a screening tool to assess internal carotid artery (ICA) disease. Recent reports suggest that the DUS may be inaccurate in over 28% of patients. We sought to evaluate the accuracy of DUS, when performed in a dedicated stroke prevention clinic (SPC).

Methods:

We retrospectively reviewed the charts of patients who had a DUS performed in our SPC, followed by conventional cerebral angiography. Three groups of patients were defined. Group 1 had DUS measured ICA stenosis of >50%; Group II had a DUS measured ICA stenosis of <50%; Group III had complete ICA occlusion on DUS.

Results:

Sixty-seven patients (69 arteries) were included in the study. There were 45 patients in Group I and based on the findings of cerebral angiography, carotid endarterectomy was considered inappropriate in only one patient. - a misclassification rate of 2.2% (95%CI: 0 – 6.5%). Group II consisted of 19 patients and on cerebral angiography, none of these patients had a stenosis of >50% - a misclassification rate of 0%. Group III consisted of five patients in whom DUS showed complete ICA occlusion. The angiogram confirmed the occlusion in all five patients – a misclassification rate of 0%. Overall, misclassification rate was 1.45% (95% CI: 0 - 4.3%).

Conclusions:

Doppler ultrasound when performed in a stroke prevention clinic (SPC), has a high accuracy in measuring ICA stenosis of >50%. Doppler ultrasound is reliable in detecting complete ICA occlusion and finally DUS is a reliable screening tool to rule out clinically significant ICA stenosis.

Résumé:

RÉSUMÉ: Introduction:

L’ultrasonographie Doppler (UD) est utilisée comme méthode de dépistage pour l’évaluation de la carotide interne (CI). Des études récentes suggèrent que l’UD serait inexacte chez plus de 28% des patients. Nous avons évalué l’exactitude de l’UD faite dans une clinique de prévention de l’accident vasculaire cérébral.

Méthodes:

Nous avons procédé à une revue rétrospective de dossiers de patients qui ont subi une UD à notre clinique, suivie d’une angiographie cérébrale conventionnelle. Les patients ont été répartis en trois groupes: à l’UD, le groupe 1 avait une sténose de la CI de plus de 50%, le groupe 2 avait une sténose de moins de 50% et le groupe 3 avait une occlusion complète de la CI.

Résultats:

Soixante-sept patients (69 artères) ont été inclus dans l’étude. Il y avait 45 patients dans le groupe 1 et, tenant compte des résultats de l’angiographie cérébrale, l’endartérectomie carotidienne était indiquée chez tous les patients sauf un, soit un taux de classification erronée de 2,2% (IC à 95% de 0 à 6,5%). À l’angiographie cérébrale, aucun des 19 patients du groupe 2 n’avait une sténose de plus de 50%, un taux de classification erronée de 0%. L’angiogramme a confirmé l’occlusion complète chez les 5 patients du groupe 3, un taux de classification erronée de 0%. Dans l’ensemble le taux de classification erronée était de 1,45% (IC à 95% de 0 à 4,3%)

Conclusions:

L’UD en clinique de prévention de l’accident vasculaire cérébral, a un haut degré d’exactitude pour mesurer une sténose de la CI de plus de 50%. L’UD est fiable pour détecter une occlusion complète de la CI et constitue également un outil de dépistage fiable pour exclure une sténose significative de la CI.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 3 , August 2005 , pp. 327 - 331
Copyright
Copyright © The Canadian Journal of Neurological 2005

References

1. NASCET, collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenosis. N Engl J Med 1991;325:445–453.Google Scholar
2. Rofsky, NM, Adleman, MA. Gadoliniun enhanced MR angiography of the carotid arteries: a small step, a giant leap? Radiology 1998;209:31–34.CrossRefGoogle Scholar
3. Anderson, GB, Ashforth, R, Steinke, DE. CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke 2000;31:2168–2174.CrossRefGoogle ScholarPubMed
4. Barnett, HJ, Broderick, JP. Carotid endarterectomy: another wake up call. Neurology 2000;55:746–747.CrossRefGoogle ScholarPubMed
5. Pryor, JC, Setton, A, Nelson, PK, Bernstein, A. Complications of diagnostic cerebral angiography and tips on avoidance. Neuroimaging Clin N Am 1996;6:751–757.Google ScholarPubMed
6. Warnock, NG, Gandhi, MR, Bergvall, U, Powell, T. Complications of intra-arterial digital subtraction angiography in patients investigated for cerebrovascular disease. Br J Radiol 1993;66:855–858.CrossRefGoogle Scholar
7. Dawson, DL, Zierler, RE, Strandness, DE. The role of duplex scanning and arteriography before carotid endarterectomy: A prospective study. J Vasc Surg 1993;18:673–683.CrossRefGoogle ScholarPubMed
8. Johnston, DCC, Goldstein, LB. Clinical carotid endarterectomy decision making. Neurology 2001;56:1009–1015.CrossRefGoogle ScholarPubMed
9. Taylor, DC, Strandness, DE. Carotid artery duplex scanning. J Clin Ultrasound 1987;15:635–644.CrossRefGoogle ScholarPubMed
10. Moneta, Gl, et al. Correlation of North American Symptomatic Carotid Endarterectomy Trial ( NASCET ) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning. J Vasc Surg 1993;17:152–159.CrossRefGoogle ScholarPubMed
11. Barnett, HJM, Taylor, DW, Eliasziw, M, et al. Benefit of carotid endarterectomy in patients with moderate or severe stenosis. N Engl J Med 1998;339:1415–1425.CrossRefGoogle ScholarPubMed
12. Qureshi, AI, Suri, MFK, Ali, Z, et al. Role of conventional angiography in evaluation of patients with carotid artery stenosis demonstrated by Doppler ultrasound in general practice. Stroke 2001;32:2287–2291.CrossRefGoogle ScholarPubMed
13. Bornstein, NM, Beloev, ZG, Norris, JW, The limitations of Diagnosis of carotid occlusion by Doppler Ultrasound. Ann Surg 1998: 207: 315–317.CrossRefGoogle Scholar
14. Zwiebel, WJ, Introduction to Vascular Technology. W.B. Saunders Company. Philadelphia, USA; 1992: 108, 115–116, 129.Google Scholar
15. Labs, KH, Jager, KA, Fitzgerald, DE, Woodcock, JP, Neurberg-Heusler, D. Diagnostic Vascular Ultrasound. Edward Arnold 1992: 198.Google Scholar