Measuring carotid artery stenosis -: Comparison of postmortem arteriograms with the planimetric gold standard

Objective Five different calliper methods for assessing the degree of carotid artery stenosis and visual estimation ("eyeballing") of postmortem carotid arteriograms were compared with the planimetric gold standard of the area reduction at the site of the stenosis. Methods During autopsy 53 carotid specimens were removed in toto from 31 neurological patients. Carotid arteries were ligated and redistended to a physiological degree for standardised three-plane arteriography. Afterwards, the entire specimen was filled with an embedding medium under the same conditions and sectioned. Slices at the site of stenoses were histologically processed. Computerised planimetric analysis of the lumen area reduction was performed and compared with the arteriographic findings. Arteriograms were evaluated by two independent observers by means of linear Common Carotid Artery (CC), the European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and squared measurements (NASCET(2), ECST2) after applying the pi r(2) function. Further, three independent observers performed eyeballing of the degree of stenosis from the postmortem arteriographies. Results Planimetry was carried out in 29 internal carotid artery (ICA) and 17 common carotid artery (CCA) stenoses ranging from 8.5 to 100 %. The smallest mean differences of the degree of stenosis in % between planimetry and arteriography were -0.5 and 0.6 %. The narrowest 95 %-limits of agreement covered a range of +/- 24.1 and 26.3 % of stenoses, and the highest correlation coefficients were both 0.9 for the CC and ECST 2 techniques, respectively. By eyeballing, the degree of stenosis was underestimated by 13.5 to 15.8 % on average. The narrowest limits of agreement between two observers for eyeballing covered a range of 35 %. Conclusion Three-plane arteriography has only a moderate accuracy and reproducibility in detecting and measuring carotid artery stenosis independent of the technique of measurement used.