Improvement in accuracy of diagnosis of carotid artery stenosis with duplex ultrasound scanning with combined use of linear array 7.5 MHz and convex array 3.5 MHz probes: validation versus 489 arteriographic procedures.

OBJECTIVE: Validity of a method to improve the accuracy of carotid artery duplex scanning was tested in comparison with arteriography. STUDY DESIGN: In 489 patients who had not previously undergone arteriography, 978 carotid arteries were examined with duplex ultrasound scanning. In method A, a linear array 7.5 MHz transducer with pulsed-wave 4.7 MHz Doppler scanning was used. For the diagnosis and grading of carotid stenosis, peak systolic and end-diastolic velocity of the Doppler waves were recorded. Method B consisted of complete ultrasound imaging and color-flow mapping with a convex array 3.5 MHz transducer with pulsed-wave 2.8 MHz Doppler scanning in all patients who had previously undergone method A. Further velocity measurements were performed at the sites of stenosis. The results of methods A and B were compared with data from neurologic assessment and arteriographic studies. RESULTS: Method B showed significantly higher diagnostic agreement with arteriography than did method A (K 95% confidence interval [CI], 0.87-0.93 vs 0.79-0.85; P <.05), and the number of mistakes in grading stenosis was significantly lower (primarily because of decreased overestimation) in patients with internal carotid kinking (>60 degrees of angulation) (P <.05), distal stenosis (>20 mm from bifurcation) (P <.01), or wide acoustic shadowing (>1 cm) (P <.01) and in those without these conditions (P <.05). Compared with arteriography, diagnostic accuracy with the new method proved higher for carotid stenoses 50% or greater, 60% or greater, 70% or greater, and 80% or greater; no statistically significant difference was found for carotid stenosis 96% or greater or for carotid occlusion. Compared with data from neurologic assessment and arteriography, method B proved more accurate than method A in designating patients for carotid endarterectomy (P =.014). CONCLUSIONS: The new method significantly improved diagnostic reliability of duplex ultrasound scanning, especially in carotid arteries with kinking, distal stenosis, or wide acoustic shadowing (32.2% of all arteries studied). In clinical practice, we suggest additional use of a lower frequency transducer in cases in which these three conditions are found or suspected at first scanning.

Arterial remodeling of the common carotid artery after aortic valve replacement in patients with aortic stenosis.

BACKGROUND AND PURPOSE: Aortic stenosis, causing flow abnormalities, disturbs the normal hemodynamics in the common carotid arteries. The aim of the present study was to investigate the remodeling process of the common carotid arteries after surgical correction of aortic stenosis. METHODS: Eleven subjects with aortic stenosis were studied before and 1 and 6 months after aortic valve replacement. Arterial diameter, intima-media thickness (IMT), and flow velocity were measured by echo-Doppler examination. Shear stress, blood flow, and pulsatility index were calculated. Blood viscosity and hematocrit were measured by standard methods. A control group was also enrolled. RESULTS: Before surgery, compared with controls, patients had lower systolic peak velocity but higher mean and end-diastolic velocity. Arterial diameter, IMT, and blood flow were comparable in the 2 groups. Blood viscosity, hematocrit, wall shear stress, and pulsatility index were markedly lower in patients. After surgery, IMT was reduced (0.741+/-0.152 versus 0.627+/-0.108 mm before and 6 months after surgery, respectively; P<0.0001), and hematocrit and blood viscosity increased, leading to increased wall shear stress (mean wall shear stress, 7.83+/-1.97 versus 9.65+/-3.12 dyne/cm(2) before and 6 months after surgery, respectively; P<0.02). CONCLUSIONS: The present results demonstrate that aortic valve replacement, in subjects with aortic stenosis, leads to reduction of the common carotid artery IMT. Wall shear stress is increased after the intervention and probably mediates the remodeling process.