Athanasoulis C A, Plomaritoglou A
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Int Angiol. 2000 Mar;19(1):1-7.
There is disagreement about the most appropriate imaging examination necessary for the preoperative assessment of the carotid bifurcation. Our objective was to find out the preferences of clinicians on this issue in one large hospital. And to determine whether and how these preferences have changed over time.
Observational, retrospective study.
Large metropolitan and university affiliated hospital. Numbers of patients per year who underwent carotid endarterectomy during 1990-1998. Numbers of patients per year who had conventional catheter carotid angiography during the same period. Assessment of the nature of preoperative carotid imaging in a sample of 400 patients (100 each in 1990, 1993, 1996 and 1998). Analysis of the types of imaging examinations by year and determination of underlying trends.
Number of carotid angiograms expressed as a percentage of carotid endarterectomies performed each year. Types of preoperative imaging examinations of the carotids and changes over time.
The number of preoperative conventional catheter angiograms decreased over time. In 1990 angiography was performed in 86% of carotid endarterectomies. In 1998 the proportion decreased to 16% (p<0.05). Conversely, the proportion of endarterectomies carried out based solely on ultrasonography increased from 6% in 1990 to 56% in 1998 (p<0.05). The proportion of endarterectomies performed based on the combined findings of ultrasound and magnetic resonance angiography increased from 3% in 1990 to 56% in 1996 and to 26% in 1998. Computed tomoangiography has not become popular. The observed reduction in the number of preoperative conventional carotid angiograms was independent of the presence/absence of symptoms, the level of serum creatinine, the subspecialty of the surgeon (vascular surgery vs neurosurgery) and the individual surgeon involved.
In one large university affiliated hospital the trend in the preoperative imaging of the carotid arteries is moving away from conventional catheter angiography. There is increasing application of ultrasound combined with magnetic resonance angiography and a more pronounced trend towards the performance of carotid endarterectomy based only on ultrasonography.
对于颈动脉分叉术前评估所需的最合适的影像学检查存在分歧。我们的目的是了解一家大型医院的临床医生在这个问题上的偏好，并确定这些偏好是否以及如何随时间变化。
观察性回顾性研究。
大型都市大学附属医院。1990 - 1998年每年接受颈动脉内膜切除术的患者数量。同期每年接受传统导管颈动脉血管造影的患者数量。对400例患者（1990年、1993年、1996年和1998年各100例）样本中的术前颈动脉成像性质进行评估。按年份分析影像学检查类型并确定潜在趋势。
颈动脉血管造影数量占每年所施行颈动脉内膜切除术数量的百分比。颈动脉术前影像学检查类型及其随时间的变化。
术前传统导管血管造影的数量随时间减少。1990年，86%的颈动脉内膜切除术患者进行了血管造影。1998年，这一比例降至16%（p<0.05）。相反，仅基于超声检查进行的内膜切除术比例从1990年的6%增至1998年的56%（p<0.05）。基于超声和磁共振血管造影联合检查结果进行的内膜切除术比例从1990年的3%增至1996年的56%，1998年降至26%。计算机断层血管造影尚未普及。术前传统颈动脉血管造影数量的减少与症状的有无、血清肌酐水平、外科医生的亚专业（血管外科与神经外科）以及参与的个体外科医生无关。
在一家大型大学附属医院，颈动脉术前成像的趋势正从传统导管血管造影转向其他检查。超声联合磁共振血管造影的应用日益增加，且仅基于超声进行颈动脉内膜切除术的趋势更为明显。
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