scholarly journals Systematic review of preoperative carotid duplex ultrasound compared with computed tomography carotid angiography for carotid endarterectomy

2019 ◽  
Vol 101 (3) ◽  
pp. 141-149 ◽  
Author(s):  
T Forjoe ◽  
M Asad Rahi
Keyword(s):  
Computed Tomography ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Sensitivity And Specificity ◽  
Systematic Reviews ◽  
Imaging Modality ◽  
Duplex Ultrasound ◽  
Carotid Angiography ◽  
Carotid Duplex ◽  
Cochrane Database

Introduction We reviewed the literature for preoperative computed tomography carotid angiography and/or carotid duplex to determine their respective sensitivity and specificity in assessing the degree of carotid stenosis. We aimed to identify whether one imaging modality can accurately identify critical stenosis in patients presenting with transient ischaemic attack or symptoms of a cerebrovascular accident requiring carotid endarterectomy. Methods Systematic search of MEDLINE, Embase, Cochrane database of systematic reviews, all Evidence-Based Medicine Reviews (Cochrane Database of Systematic Reviews, ACP Journal club, Database of Abstracts of Reviews of Effects, Cochrane Clinical Answers, Cochrane Controlled Trials Register, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database) for primary studies relating to computed tomography carotid angiography (CTA) and/or carotid duplex ultrasound (CDU). Studies included were published between 1990 and 2018 and focused on practice in the UK, Europe and North America. Results The sensitivity and specificity of CTA and CDU are comparable. CDU is safe and readily available in the clinical environment hence its use in the initial preoperative assessment of carotid stenosis. CDU is an adequate imaging modality for determining stenosis greater than 70%; sensitivity and specificity are improved when the criteria for determining greater than 70% stenosis are adjusted. Vascular laboratories opting to use duplex as their sole imaging modality should assess the sensitivity and specificity of their own duplex procedure before altering practice to preoperative single imaging for patients. Conclusions The sensitivity and specificity of CTA (90.6% and 93%, respectively) and CDU (92.3% and 89%, respectively) are comparable. Both are dependent on criteria used in vascular laboratories. CDU sensitivity and specificity was improved to 98.7% and 94.1%, respectively, where peak systolic velocity and end diastolic velocity were assessed. Either modality can be used to determine greater than 70% stenosis, although a secondary imaging modality may be required for cases of greater than 50% stenosis.

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

Defining the Role of Duplex Ultrasound Assessment to Determine Severity of Arterial Calcification: An Analysis of the Superficial Femoral Artery

2020 ◽  
Vol 44 (2) ◽  
pp. 74-78
Author(s):  
Charlotte Taylor ◽  
Lukasz P. Zielinski ◽  
Mohammed M. Chowdhury ◽  
Patrick A. Coughlin
Keyword(s):  
Computed Tomography ◽  
Correlation Coefficient ◽  
Lower Limb ◽  
Imaging Modality ◽  
Objective Assessment ◽  
Duplex Ultrasound ◽  
Arterial Calcification ◽  
Gold Standard Method ◽  
Calcification Score

Lower limb arterial calcification associates with poor cardiovascular outcomes. The gold standard method of assessment is via computed tomography, yet duplex is our primary imaging modality. Currently, there is no standardized objective assessment of lower limb arterial calcification using duplex. We aimed to define the role of duplex in the assessment of lower limb arterial calcification. Initial consensus was achieved between a cohort of vascular scientists on objective imaging specific markers of lower limb arterial calcification severity using duplex. This resulted in objective descriptions to grade calcification from 0 to 3 (no calcification through to severe calcification) which formed the duplex lower limb arterial calcification score. Reproducibility of the duplex lower limb arterial calcification score was assessed and further validation was undertaken by comparing the duplex lower limb arterial calcification with computed tomography–based assessment in a separate cohort of 44 patients investigated with both modalities. The intra- and inter-class correlation coefficient were > 0.87 . The Spearman rank correlation coefficient between the duplex and CT based arterial calcium measurements was (ρ = 0.644, P < .001). The duplex lower limb arterial calcification score provides a standardized and reproducible modality for assessment of lower limb arterial calcification and may aid with risk stratification in patients with peripheral arterial disease.

scholarly journals The value and economic analysis of routine postoperative carotid duplex ultrasound surveillance after carotid endarterectomy

2015 ◽  
Vol 62 (2) ◽  
pp. 378-384 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Mohit Srivastava ◽  
Zachary AbuRahma ◽  
Will Jackson ◽  
Albeir Mousa ◽  
...  
Keyword(s):  
Economic Analysis ◽  
Carotid Endarterectomy ◽  
Duplex Ultrasound ◽  
Carotid Duplex ◽  
Ultrasound Surveillance

From embolization to remodeling: the need for early carotid endarterectomy in symptomatic carotid plaques

Vascular ◽  
2011 ◽  
Vol 19 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Laura Capoccia ◽  
Caterina Pelonara ◽  
Cesira Imondi ◽  
Enrico Sbarigia ◽  
Francesco Speziale
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Duplex Ultrasound ◽  
Left Carotid Artery ◽  
Symptomatic Carotid ◽  
Atheromatous Plaques ◽  
Dynamic Structures ◽  
Arterial Stenoses

Atheromatous plaques are dynamic structures undergoing continuous remodeling. Duplex ultrasound is now an accepted technique to classify the severity of arterial stenoses. It gives information about the ultrasonic echogenicity of tissue, the plaque surface and the velocity of blood flowing through vessels with the latest equipment. We report the case of a 59-year-old male patient with left hemispheric stroke and a 50% left carotid artery stenosis whose remodeling and reabsorption developed throughout three months from the onset of symptoms. Plaque surface and structural echomorphology assessment and standardization, along with the degree of carotid stenosis, might be helpful in identifying patients most likely to benefit from carotid endarterectomy.

scholarly journals Physician Approaches to Imaging and Revascularization for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Aravind Ganesh ◽  
Benjamin Beland ◽  
Gordon A.E. Jewett ◽  
David J.T. Campbell ◽  
Malavika Varma ◽  
...  
Keyword(s):  
Decision Making ◽  
Carotid Artery ◽  
Qualitative Study ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenting ◽  
Practice Patterns ◽  
Imaging Modality ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background Evidence informing the choice between carotid endarterectomy and carotid artery stenting for acutely symptomatic carotid stenosis (“hot carotid”) is dated and does not factor in contemporary therapies or techniques. The optimal imaging modality is also uncertain. We explored the attitudes of stroke physicians regarding imaging and revascularization of patients with acute symptomatic carotid stenosis. Methods We used a qualitative descriptive methodology to examine decision‐making approaches and opinions of physicians regarding the choice of imaging and revascularization procedures for hot carotids. We conducted semistructured interviews with purposive sampling of 22 stroke physicians from 16 centers in 6 world regions and various specialties: 11 neurologists, 3 geriatricians, 5 interventional neuroradiologists, and 3 neurovascular surgeons. Results Qualitative analysis revealed several themes regarding clinical decision‐making for hot carotids. Whereas CT angiography was favored by most participants, timely imaging availability, breadth of information gained, and surgeon/interventionalist preferences were important themes influencing the choice of imaging modality. Carotid endarterectomy was generally favored over carotid artery stenting, but participants’ choice of intervention was influenced by healthcare system factors such as use of multidisciplinary vascular teams and operating room or angiography suite availability, and patient factors like age and infarct size. Areas of uncertainty included choice of imaging modality for borderline stenosis, utility of carotid plaque imaging, timing of revascularization, and the role of intervention with borderline stenosis or intraluminal thrombus. Conclusions This qualitative study highlights practice patterns common in different centers around the world, such as the general preference for CT angiography imaging and carotid endarterectomy over carotid artery stenting but also identified important differences in availability, selection, and timing of imaging and revascularization options. To gain widespread support, future carotid trials will need to accommodate identified variations in practice patterns and address areas of uncertainty, such as optimal timing of revascularization with modern best medical management and risk‐stratification with imaging features other than just degree of stenosis.

A critical analysis of cerebral computed tomography scanning before elective carotid endarterectomy and its correlation to carotid stenosis

Surgery ◽  
1996 ◽  
Vol 119 (3) ◽  
pp. 248-251 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Patrick A. Robinson ◽  
Scott M. Killmer ◽  
John Michael Kioschos ◽  
Michael D. Roberts
Keyword(s):  
Computed Tomography ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Critical Analysis ◽  
Computed Tomography Scanning ◽  
Cerebral Computed Tomography ◽  
Tomography Scanning

Surveillance Duplex Ultrasound After Carotid Endarterectomy: Contralateral Carotid Stenosis, Restenosis and Cost

2017 ◽  
Vol 41 ◽  
pp. 12-13
Author(s):  
R. Clement Darling ◽  
John B. Taggert ◽  
Yaron Sternbach ◽  
Sean P. Roddy ◽  
Paul B. Kreienberg
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Duplex Ultrasound

scholarly journals Routine Postoperative Carotid Duplex Ultrasound Surveillance After Carotid Endarterectomy

2014 ◽  
Vol 60 (6) ◽  
pp. 1720
Author(s):  
Ali F. AbuRahma ◽  
Mohit Srivastava ◽  
Zachary AbuRahma ◽  
Will Jackson ◽  
Patrick A. Stone ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Duplex Ultrasound ◽  
Carotid Duplex ◽  
Ultrasound Surveillance

scholarly journals Digital subtraction angiography (DSA) is superior to duplex ultrasound in diagnosis of extracranial carotid stenosis - a comparative study

2014 ◽  
Vol 43 (2) ◽  
pp. 67-71
Author(s):  
Subash Kanti Dey ◽  
Lipy Bakshi ◽  
Md Shahidullah ◽  
Ahsan Habib ◽  
Manabendra Battacharya ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Digital Subtraction Angiography ◽  
Internal Carotid ◽  
Duplex Ultrasound ◽  
Digital Subtraction ◽  
Sensitivity Specificity ◽  
Carotid Vessels

Digital subtraction angiography (DSA) is the gold standard investigation to assess the extracranial stenosis of carotid vessels. But this is an invasive diagnostic tool. So it is still a controversial issue whether duplex ultrasound is an alternative to DSA for measurement of stenosis of carotid vessels. This prospective crossectional observational study was conducted in the department of Neurology, BSMMU, Dhaka from May 2012 to April 2013 to assess the diagnostic accuracy of duplex ultrasound and its potential to replace DSA before performing carotid endarterectomy (CEA) and carotid stenting. Total of 38 patients, 33 patients of nondisabling ischaemic stroke and 5 patients with history of TIAs whose extracranial carotid stenosis was >50% on duplex ultrasound were selected for DSA. DSA was done on these vessels and stenosis was measured using NASCET criteria. Results of USD and DSA were compared to determine the sensitivity, specificity and accuracy of duplex ultrasound (USD). At 70% stenosis of right internal carotid artery and left internal carotid artery the sensitivity, specificity and accuracy were 93.8%, 63.7%, 89.5% and 93.3%, 75%, 89.5% respectively. This level of diagnostic efficiency of USD is less than that of DSA of carotid arteries. It was found in this study that, USD underestimates or overestimates the degree of carotid stenosis. DSA was safe and effective in determining stenosis in this study & there was no 67 complication. So before taking any decision for carotid endarterectomy or carotid artery stenting, digital subtraction angiography of carotid vessels should be done. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21385 Bangladesh Med J. 2014 May; 43 (2): 67-71

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