Clinical carotid endarterectomy decision making: noninvasive vascular imaging versus angiography.
Neurology
; 56(8): 1009-15, 2001 Apr 24.
Article
em En
| MEDLINE
| ID: mdl-11320170
ABSTRACT
OBJECTIVE:
Carotid endarterectomy (CEA) is frequently performed based solely on noninvasive vascular imaging (NVI) results (duplex ultrasound, DU; magnetic resonance angiography, MRA; CT angiography, CTA). The authors determined how often intra-arterial contrast angiography (ANGIO) alters a CEA decision as compared to NVI in clinical practice.METHODS:
Reports of all NVI studies in 569 consecutive patients undergoing ANGIO at an academic medical center (AMC, n = 360) and a community hospital (CH, n = 209) over 3 years were reviewed. Patients were classified as to whether CEA was indicated based on each study. Misclassification rates, sensitivities, specificities, positive (PPV) and negative (NPV) predictive values were calculated.RESULTS:
CTA was performed infrequently (2.5%) and not considered further. Misclassification rates for CEA based on DU in the AMC and CH were similar. The misclassification rate for DU alone was 28% (95% CI 24,32), and for MRA alone was 18% (95% CI 11,25). Both NVI were done in 11% of patients, with a misclassification rate of 7.9% (95% CI 0,16) when the two were concordant (76% of studies). DU had a sensitivity of 87% (95% CI 83,91), specificity 46% (95% CI 38,54), PPV 73% (95% CI 68,78) and NPV 68% (95% CI 60,77). MRA had a sensitivity of 75% (95% CI 63,87), specificity 88% (95% CI 80,96), PPV 84% (95% CI 73,95) and NPV 80% (95% CI 70, 90). The sensitivity of concordant NVIs was 96% (95% CI 88,100), specificity 85% (95% CI 65,100), PPV 93% (95% CI 81,100) and NPV 92% (95% CI 76,100).CONCLUSION:
These data suggest that surgical decisions should be made with caution if based on the results of noninvasive studies, particularly DU performed alone. Concordant DU and MRA results in a lower misclassification rate than either test used alone.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Tomografia Computadorizada por Raios X
/
Endarterectomia das Carótidas
/
Estenose das Carótidas
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Ultrassonografia Doppler Dupla
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Angiografia por Ressonância Magnética
Tipo de estudo:
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Neurology
Ano de publicação:
2001
Tipo de documento:
Article
País de afiliação:
Estados Unidos
País de publicação:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA