Selection of patients for carotid endarterectomy

被引:23
作者
Golledge, J [1 ]
Ellis, M [1 ]
Sabharwal, T [1 ]
Sikdar, T [1 ]
Davies, AH [1 ]
Greenhalgh, RM [1 ]
机构
[1] Charing Cross Hosp, Imperial Coll Sci Technol & Med, Dept Surg & Radiol, London, England
关键词
D O I
10.1016/S0741-5214(99)70184-9
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: The aim of this study was the definition of the duplex scan parameters that best select patients for carotid endarterectomy. Methods: This study was set in a regional vascular unit. Duplex scanning and angiography were performed prospectively on 50 patients who were symptomatic (100 carotid bifurcation) to identify the most accurate and sensitive duplex scan criteria to identify an 80% to 99% stenosis according to the European Carotid Symptomatic Trial. With data from the European Carotid Symptomatic Trial, we estimated the effect of three different approaches used to select patients for carotid endarterectomy. The first approach was the selection of patients for carotid surgery on the basis of duplex scanning alone with the most accurate duplex scan criteria (approach I). The second approach was the selection of patients for carotid surgery on the basis of duplex scanning alone with a 100% sensitive duplex scan criteria (approach II). The third approach was the selection of patients for angiography with duplex scanning (100% sensitive criteria) and then the use of angiography to define which patients should undergo surgery (approach III). Results: All three approaches appeared to have a similar potential in stroke reduction. However, approach I, which minimized the number of patients who underwent surgery (19% less than approach II) or invasive imaging (65% less than approach III), appeared to be the most appropriate. Conclusion: These data support the selection of patients for carotid endarterectomy on the basis of duplex scanning alone. The duplex scan criteria should be validated against angiography.
引用
收藏
页码:122 / 130
页数:9
相关论文
共 24 条
[1]   MEASURING CAROTID STENOSIS - TIME FOR A REAPPRAISAL [J].
ALEXANDROV, AV ;
BLADIN, CF ;
MAGGISANO, R ;
NORRIS, JW .
STROKE, 1993, 24 (09) :1292-1296
[2]   Grading carotid stenosis with ultrasound - An interlaboratory comparison [J].
Alexandrov, AV ;
Vital, D ;
Brodie, DS ;
Hamilton, P ;
Grotta, JC .
STROKE, 1997, 28 (06) :1208-1210
[3]   THE LIMITATIONS OF DIAGNOSIS OF CAROTID OCCLUSION BY DOPPLER ULTRASOUND [J].
BORNSTEIN, NM ;
BELOEV, ZG ;
NORRIS, JW .
ANNALS OF SURGERY, 1988, 207 (03) :315-317
[4]   DETECTION OF CAROTID STENOSIS - FROM NASCET RESULTS TO CLINICAL-PRACTICE [J].
CHANG, YJ ;
GOLBY, AJ ;
ALBERS, GW .
STROKE, 1995, 26 (08) :1325-1328
[5]   Surgery for prevention of stroke [J].
Donnan, GA ;
Davis, SM ;
Chambers, BR ;
Gates, PC .
LANCET, 1998, 351 (9113) :1372-1373
[6]   ACCURACY AND PROGNOSTIC CONSEQUENCES OF ULTRASONOGRAPHY IN IDENTIFYING SEVERE CAROTID-ARTERY STENOSIS [J].
ELIASZIW, M ;
RANKIN, RN ;
FOX, AJ ;
HAYNES, RB ;
BARNETT, HJM .
STROKE, 1995, 26 (10) :1747-1752
[7]   Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European carotid surgery trial (ECST) [J].
Farrell, B ;
Fraser, A ;
Sandercock, P ;
Slattery, J ;
Warlow, CP .
LANCET, 1998, 351 (9113) :1379-1387
[8]   COLOR-FLOW DUPLEX SCANNING OF CAROTID ARTERIES - NEW VELOCITY CRITERIA-BASED ON RECEIVER OPERATOR CHARACTERISTIC ANALYSIS FOR THRESHOLD STENOSES USED IN THE SYMPTOMATIC AND ASYMPTOMATIC CAROTID TRIALS [J].
FAUGHT, WE ;
MATTOS, MA ;
VANBEMMELEN, PS ;
HODGSON, KJ ;
BARKMEIER, LD ;
RAMSEY, DE ;
SUMNER, DS .
JOURNAL OF VASCULAR SURGERY, 1994, 19 (05) :818-828
[9]   Carotid duplex criteria for a 60% or greater angiographic stenosis: Variation according to equipment [J].
Fillinger, MF ;
Baker, RJ ;
Zwolak, RM ;
Musson, A ;
Lenz, JE ;
Mott, J ;
Bech, FR ;
Walsh, DB ;
Cronenwett, JL .
JOURNAL OF VASCULAR SURGERY, 1996, 24 (05) :856-864
[10]  
Golledge J, 1996, BRIT J SURG, V83, P1234