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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2004 September;11(3):115-23
Echo-color Doppler ultrasonography and 3D spiral computed tomography in the evaluation of carotid artery disease requiring surgery
Lazzaro D. 1, Varetto G. 1, Conforti M. 1, Debernardi S. 2, Regge D. 2, Raso A. M. 1, Rispoli P. 1
1 School of Specialization in Vascular Surgery University of Turin, Turin, Italy
2 Radiology Service, Institute for the Study and Cure of Cancer Candiolo (Turin), Italy
Aim. The purpose of this study was to evaluate the diagnostic capabilities of 3D spiral computed tomography (sCT) with volume rendering versus echo color-Doppler ultrasonography (ECD) of the supraortic trunks in the preoperative assessment of patients with extracranial carotid artery disease referred for thromboendarterectomy (TEA).
Methods. In all, 144 carotid arteries were examined in 72 patients, 33 of which underwent TEA. Operating specimens and models built from the atherosclerotic plaques removed at surgery furnished the gold standard against which the 2 methods were compared in reference to the ability of the procedures to quantify the percentage of stenosis based on the North American Symptomatic Carotid Endarterectomy Trial (NASCET) classification, to define the composition of the atherosclerotic plaque and to determine the presence of kinking and coiling and ulceration. Analysis of statistical significance was performed.
Results. Sensitivity and specificity of sCT and ECD was 87% and 100% versus 81% and 100%, respectively, for revealing stenosis; 100% and 100% versus 44% and 96%, respectively, for kinking and coiling; 71% and 100% versus 14% and 100%, respectively, for ulceration.
Conclusion. Spiral CT was found to be more accurate and precise than ECD in the assessment of carotid artery disease and proved a useful tool as a second level preoperative procedure and as a valuable alternative to angiography.