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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2005 September;12(3):91-9
Color flow Doppler versus Magnetic Resonance angiography for preoperative evaluation of the extracranial carotid vessels. Comparative and operative findings
Taurino M. 1, Battocchio C. 1, Maggiore C. 1, Speranza A. 1, Bonamini M. 2, Proganò T. 3, Sanna F. M. 3, Faraglia V. 1
1 Unit of Vascular Surgery, S. Andrea Hospital Faculty of Medicine and Surgery II La Sapienza University, Rome, Italy
2 Unit of Neuroradiology, S. Andrea Hospital Faculty of Medicine and Surgery II La Sapienza University, Rome, Italy
3 Department of Geoeconomics Linguistics and Statistics La Sapienza University, Rome, Italy
Aim. The aim of the paper is to confirm the validity of color flow Doppler (CFD) in the diagnosis of extracranial carotid artery disease and to assess the diagnostic performance of CFD and magnetic resonance angiography (MRA) compared with the ex vivo intraoperative findings.
Methods. Between January and July 2004, 40 outpatients were studied. Preoperative diagnostic imaging in all patients comprised CFD and MRA of the extracranial carotid arteries. Plaques from all patients were evaluated ex vivo after carotid thromboendarterectomy (TEA) to assess the degree of stenosis and structural and surface characteristics of carotid plaques.
Results. The intraoperative findings were: 4 stenosis below 60%, 6 from 60% to 70%, 15 from 70% to 80%, 10 from 80% to 90%, 4 preocclusive stenosis, 1 pseudo-occlusion; 10 smooth, 28 irregular, 2 ulcerated surfaces; 8 fibrous, 23 fibrous-calcified, 9 calcified plaques. The CFD data showed: 4 stenosis less than 60%, 6 from 60% to 70%, 14 from 70% to 80%, 12 from 80% to 90%, 3 preocclusive stenosis, 1 pseudo-occlusion; 12 smooth, 26 irregular, 2 ulcerated surfaces; 8 fibrous, 23 fibrous-calcified, 9 calcified plaques. The MRA evaluation evidenced: 3 stenosis less than 60%, 7 from 60% to 70%, 14 from 70% to 80%, 11 from 80% to 90%, 2 preocclusive stenosis, 1 pseudo-occlusion, 1 obstruction; 23 smooth, 16 irregular, 1 ulcerated surfaces; impossibility to define plaque contents.
Conclusion. Our study confirms CFD ultrasonography as a reliable imaging modality and the preferred method for mass screening of extracranial carotid artery disease. To confirm doubtful CFD findings MRA can replace digital subtraction angiography (DSA). Intraoperative macroscopical assessment of the arterial plaque provides a standard for assessing objectively the results.