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

scholarly journals Digital Subtraction Angiogram (DSA) is Superior to Duplex Ultrasound (USD) in Diagnosis of Extracranial Carotid Stenosis - A Comparative Study

1970 ◽  
Vol 12 (1) ◽  
pp. 12-16
Author(s):  
Rajib Nayan Chowdhury ◽  
Kazi Mohibur Rahman ◽  
Shariff Uddin Khan ◽  
Rabindranath Sarker ◽  
Shahriar Nabi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Arteries ◽  
Duplex Ultrasound ◽  
Diagnostic Efficiency ◽  
Digital Subtraction ◽  
Key Word ◽  
Digital Subtraction Angiogram ◽  
Sensitivity Specificity ◽  
Carotid Vessels

This retrospective crossectional observational study was conducted in the department of Neurology, DMCH, Dhaka from December 2008 to December 2009. This study included a total of 40 patients, out of all, 35 suffered from nondisabling ischaemic stroke, other 5 had TIAs. Patients with ≥50% extracranial carotid stenosis on Duplex Ultrasound were then 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). ROC graph of RICA and LICA showed that most left and upper point of the curve lies at the level of 70% stenosis. At ≥70% stenosis of RICA and LICA the Sensitivity, Specificity and Accuracy were 91.2%, 50%, 85% and 86.83%, 50%, 85% respectively. This level of diagnostic efficiency of USD is less than that of DSA of carotid arteries. Study revealed that USD underestimates or overestimates degree of carotid stenosis, and DSA is safe and effective in determining stenosis. So before taking any decision to intervene in the form of Carotid endarterectomy or carotid artery stenting, it would be wise to do Digital Subtraction Angiogram of carotid vessels. Key word: Digital Subtraction Angiogram; Duplex Ultrasound; carotid vessels. DOI: 10.3329/jom.v12i1.6926J Medicine 2011; 12 : 12-16

scholarly journals Internal carotid artery rupture successfully rescued after resection of locally advanced mucosal malignant melanoma of the eustachian tube: a case report

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096300
Author(s):  
Jianfeng Li ◽  
Xiaohong Chen ◽  
Jing Zhou
Keyword(s):  
Malignant Melanoma ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Digital Subtraction Angiography ◽  
Eustachian Tube ◽  
Internal Carotid ◽  
Shock Treatment ◽  
Comprehensive Treatment ◽  
Digital Subtraction ◽  
Mucosal Malignant Melanoma

Mucosal melanoma of the eustachian tube is a rare and highly malignant tumour. Local radical resection combined with radiotherapy and systemic chemotherapy is a classic treatment strategy for this tumour. The internal carotid artery (ICA) is easily damaged when this tumour is removed. Once the ICA ruptures and causes haemorrhage, it can be fatal. We report a case of mucosal malignant melanoma of the eustachian tube with ICA rupture and haemorrhage in a 62-year-old woman 3 days after resection of the tumour. After successful emergency endotracheal intubation, anti-shock treatment was performed. Further, the ICA was examined using digital subtraction angiography under general anaesthesia and the bleeding site was embolized. The patient recovered uneventfully after surgery and was discharged from hospital without hemiplegia, aphasia, or other intracranial complications. Because of economic reasons, the patient discontinued comprehensive treatment after being discharged from the hospital. Finally, she developed bone and kidney metastases 8 months after surgery and died of distant metastases 1.5 years later. When removing eustachian tube lesions, the ICA must be particularly protected. Once the ICA ruptures and there is postoperative haemorrhage, prevention of airway asphyxia, timely anti-shock treatment, and emergency digital subtraction angiography and vascular embolization are effective treatment methods.

Common Carotid Artery Imbrication as an Adjunct to Carotid Endarterectomy to Prevent Postoperative Carotid Kinking

2007 ◽  
Vol 73 (3) ◽  
pp. 276-278
Author(s):  
Juergen Falkensammer ◽  
Albert G. Hakaim ◽  
W. Andrew Oldenburg ◽  
Todd B. Berland
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Duplex Ultrasound ◽  
Retrospective Chart Review ◽  
Patch Angioplasty ◽  
The Common

Mobilization of a tortuous carotid artery during endarterectomy may produce redundancy of the carotid artery, and kinking. We reviewed our experience with common carotid artery (CCA) imbrication as a technique to shorten the common and internal carotid artery postendarterectomy and to avoid carotid kinking. A retrospective chart review of 163 patients who underwent carotid endarterectomy by the same surgeon between August 1998 and February 2006 was performed. All patients underwent conventional endarterectomy via a longitudinal arteriotomy with an indwelling shunt and patch angioplasty. Patients undergoing concomitant carotid artery imbrication were identified. Twelve patients who underwent carotid imbrication were identified. The mean age was 74.9 ± 8.8 years. Nine patients underwent imbrication of the CCA, and in three cases, the internal carotid artery was plicated. Follow-up duplex ultrasound examinations were available for 10 individuals and mean follow-up time was 10.7 months (range, 1–58 months). There were no cases of peri- or postoperative cerebral accidents and there was no case of restenosis. CCA imbrication as an adjunct to carotid endarterectomy is a feasible technique in preventing postoperative carotid kinking.

Duplex criteria for determining ≥50% and ≥80% internal carotid artery stenosis following carotid endarterectomy with patch angioplasty

Vascular ◽  
2011 ◽  
Vol 19 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Ali F AbuRahma
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Predictive Value ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Optimal Velocity ◽  
Diastolic Velocity ◽  
Asymptomatic Patients ◽  
Sensitivity Specificity

The purpose of this study was to determine optimal velocities for detecting ≥50% and ≥80% restenosis prior to considering carotid intervention/carotid artery stenting (CAS) after carotid endarterectomy (CEA) with patching in symptomatic and asymptomatic patients. Two hundred CEA patients with 195 pairs of imaging (duplex ultrasound versus computed tomography angiography [CTA]/carotid arteriography) were analyzed. Peak systolic velocities (PSVs), end diastolic velocity (EDV) and internal carotid artery/common carotid artery (ICA/CCA) ratios were correlated to angiography. Receiver operator characteristic (ROC) curves determined optimal velocity criteria in detecting ≥50% and ≥80% restenosis. The mean PSVs for ≥50% and ≥80% restenosis were 248 and 404 c/s, respectively ( P < 0.001). A PSV of ≥213 c/s was optimal for ≥50% restenosis with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of 99%, 100%, 100%, 98% and 99%, respectively. An ICA PSV of 274 c/s was optimal for ≥80% restenosis with sensitivity, specificity, PPV, NPV and OA of 100%, 91%, 99%, 100% and 99%, respectively. ROC analysis showed that PSVs were significantly better than EDVs and ICA/CCA ratios in detecting ≥50% restenosis. Standard duplex velocity criteria should be revised after CEA using patching. Specific carotid duplex velocities can be used to detect ≥50% and ≥80% restenosis after CEA with patch closure prior to carotid intervention/CAS.

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