Helical CT angiography in the preoperative evaluation of carotid artery stenosis

M. Cinat, C. T. Lane, H. Pham, A. Lee, S. E. Wilson, I. Gordon, L. M. Reilly, M. Cinat, E. Strandness, Gregory (Greg) Moneta

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Purpose: To determine the utility and accuracy of helical CT angiography (CTA) in the evaluation of carotid artery stenosis. Methods: A comparison of CTA and conventional arteriogram was performed in 53 patients undergoing evaluation for carotid artery stenosis. Ninety-six carotid systems were evaluable. CTA stenosis was determined by the percent of area reduction seen on axial images through the level of greatest narrowing. MIP images were used to identify the point of maximal stenosis and to visualize overall vascular anatomy. The percent diameter stenosis was measured on conventional arteriograms using strict North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) criteria. Results: Significant correlation was found between CTA and arteriography (NASCET method R = 0.87, ECST method R = 0.87, p <0.001). Using NASCET >60% as an indicator for disease, CTA had a sensitivity of 87%, specificity of 90%, accuracy of 89%, negative predictive value of 88%, and positive predictive value of 89%. CTA identified plaque characteristics such as ulcerations (8), occlusion (10), fatty plaques (22), calcifications (48), and fibrosis (2). CTA underestimated 2 cases of short segment stenoses because of volume averaging, but this discrepancy was detected by duplex scan. No complications or renal dysfunction occurred with CTA; 1 patient became symptomatic during arteriography, necessitating termination of the procedure. Conclusion: CTA is a safe, non-invasive technique that precisely measures carotid artery area reduction and highly correlates to conventional arteriography. With this new technology, the current standards for carotid artery imaging may need to be reevaluated, and the precise role for helical CTA more clearly defined.

Original languageEnglish (US)
Pages (from-to)290-300
Number of pages11
JournalJournal of Vascular Surgery
Volume28
Issue number2
DOIs
StatePublished - 1998
Externally publishedYes

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Spiral Computed Tomography
Carotid Stenosis
Pathologic Constriction
Angiography
Carotid Endarterectomy
Carotid Arteries
Computed Tomography Angiography
Blood Vessels
Anatomy
Fibrosis
Technology
Kidney
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Helical CT angiography in the preoperative evaluation of carotid artery stenosis. / Cinat, M.; Lane, C. T.; Pham, H.; Lee, A.; Wilson, S. E.; Gordon, I.; Reilly, L. M.; Cinat, M.; Strandness, E.; Moneta, Gregory (Greg).

In: Journal of Vascular Surgery, Vol. 28, No. 2, 1998, p. 290-300.

Research output: Contribution to journalArticle

Cinat, M, Lane, CT, Pham, H, Lee, A, Wilson, SE, Gordon, I, Reilly, LM, Cinat, M, Strandness, E & Moneta, GG 1998, 'Helical CT angiography in the preoperative evaluation of carotid artery stenosis', Journal of Vascular Surgery, vol. 28, no. 2, pp. 290-300. https://doi.org/10.1016/S0741-5214(98)70165-X
Cinat, M. ; Lane, C. T. ; Pham, H. ; Lee, A. ; Wilson, S. E. ; Gordon, I. ; Reilly, L. M. ; Cinat, M. ; Strandness, E. ; Moneta, Gregory (Greg). / Helical CT angiography in the preoperative evaluation of carotid artery stenosis. In: Journal of Vascular Surgery. 1998 ; Vol. 28, No. 2. pp. 290-300.
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abstract = "Purpose: To determine the utility and accuracy of helical CT angiography (CTA) in the evaluation of carotid artery stenosis. Methods: A comparison of CTA and conventional arteriogram was performed in 53 patients undergoing evaluation for carotid artery stenosis. Ninety-six carotid systems were evaluable. CTA stenosis was determined by the percent of area reduction seen on axial images through the level of greatest narrowing. MIP images were used to identify the point of maximal stenosis and to visualize overall vascular anatomy. The percent diameter stenosis was measured on conventional arteriograms using strict North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) criteria. Results: Significant correlation was found between CTA and arteriography (NASCET method R = 0.87, ECST method R = 0.87, p <0.001). Using NASCET >60{\%} as an indicator for disease, CTA had a sensitivity of 87{\%}, specificity of 90{\%}, accuracy of 89{\%}, negative predictive value of 88{\%}, and positive predictive value of 89{\%}. CTA identified plaque characteristics such as ulcerations (8), occlusion (10), fatty plaques (22), calcifications (48), and fibrosis (2). CTA underestimated 2 cases of short segment stenoses because of volume averaging, but this discrepancy was detected by duplex scan. No complications or renal dysfunction occurred with CTA; 1 patient became symptomatic during arteriography, necessitating termination of the procedure. Conclusion: CTA is a safe, non-invasive technique that precisely measures carotid artery area reduction and highly correlates to conventional arteriography. With this new technology, the current standards for carotid artery imaging may need to be reevaluated, and the precise role for helical CTA more clearly defined.",
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AU - Lane, C. T.

AU - Pham, H.

AU - Lee, A.

AU - Wilson, S. E.

AU - Gordon, I.

AU - Reilly, L. M.

AU - Cinat, M.

AU - Strandness, E.

AU - Moneta, Gregory (Greg)

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N2 - Purpose: To determine the utility and accuracy of helical CT angiography (CTA) in the evaluation of carotid artery stenosis. Methods: A comparison of CTA and conventional arteriogram was performed in 53 patients undergoing evaluation for carotid artery stenosis. Ninety-six carotid systems were evaluable. CTA stenosis was determined by the percent of area reduction seen on axial images through the level of greatest narrowing. MIP images were used to identify the point of maximal stenosis and to visualize overall vascular anatomy. The percent diameter stenosis was measured on conventional arteriograms using strict North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) criteria. Results: Significant correlation was found between CTA and arteriography (NASCET method R = 0.87, ECST method R = 0.87, p <0.001). Using NASCET >60% as an indicator for disease, CTA had a sensitivity of 87%, specificity of 90%, accuracy of 89%, negative predictive value of 88%, and positive predictive value of 89%. CTA identified plaque characteristics such as ulcerations (8), occlusion (10), fatty plaques (22), calcifications (48), and fibrosis (2). CTA underestimated 2 cases of short segment stenoses because of volume averaging, but this discrepancy was detected by duplex scan. No complications or renal dysfunction occurred with CTA; 1 patient became symptomatic during arteriography, necessitating termination of the procedure. Conclusion: CTA is a safe, non-invasive technique that precisely measures carotid artery area reduction and highly correlates to conventional arteriography. With this new technology, the current standards for carotid artery imaging may need to be reevaluated, and the precise role for helical CTA more clearly defined.

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