用于定义颈动脉支架内再狭窄严重程度的最佳颈动脉双功超声速度标准。
Optimal carotid duplex velocity criteria for defining the severity of carotid in-stent restenosis.
作者信息
AbuRahma Ali F, Abu-Halimah Shadi, Bensenhaver Jessica, Dean L Scott, Keiffer Tammi, Emmett Mary, Flaherty Sarah
机构信息
Department of Surgery, Robert C Byrd Health Sciences Center, West Virginia University, Charleston, WV 25304, USA.
出版信息
J Vasc Surg. 2008 Sep;48(3):589-94. doi: 10.1016/j.jvs.2008.04.004. Epub 2008 Jun 30.
BACKGROUND
The optimal duplex ultrasound (DUS) velocity criteria to determine in-stent carotid restenosis are controversial. We previously reported the optimal DUS velocities for >or=30% in-stent restenosis. This prospective study will further define the optimal velocities in detecting various severities of in-stent restenosis: >or=30%, >or=50%, and 80% to 99%.
METHODS
The analysis included 144 patients who underwent carotid artery stenting as a part of clinical trials. All patients had completion arteriograms and underwent postoperative carotid DUS imaging, which was repeated at 1 month and every 6 months thereafter. Patients with peak systolic velocities (PSVs) of the internal carotid artery (ICA) of >or=130 cm/s underwent carotid computed tomography (CT)/angiogram. The PSVs and end-diastolic velocities of the ICA and common carotid artery (CCA) and the PSV of the ICA/CCA ratios were recorded. Receiver operating characteristic curve (ROC) analysis was used to determine the optimal velocity criteria for the diagnosis of >or=30, >or=50, and >or=80% restenosis.
RESULTS
The mean follow-up was 20 months (range, 1-78 months). Available for analysis were 215 pairs of imaging (DUS vs CTA/angiography) studies. The accuracy of CTA vs carotid arteriogram was confirmed in a subset of 22 patients (kappa = 0.81). The ROC analysis demonstrated that an ICA PSV of >or=154 cm/s was optimal for >or=30% stenosis with a sensitivity of 99%, specificity of 89%, positive-predictive value (PPV) of 96%, negative-predictive value (NPV) of 97%, and overall accuracy (OA) of 96%. An ICA EDV of 42 cm/s had sensitivity, specificity, PPV, NPV, and OA in detecting >or=30% stenosis of 86%, 62%, 87%, 60%, and 80%, respectively. An ICA PSV of >or=224 cm/s was optimal for >50% stenosis with a sensitivity of 99%, specificity of 90%, PPV of 99%, NPV of 90%, and OA of 98%. An ICA EDV of 88 cm/s had sensitivity, specificity, PPV, NPV, and OA in detecting >or=50% stenosis of 96%, 100%, 100%, 100%, 53%, and 96%. An ICA/CCA ratio of 3.439 had sensitivity, specificity, PPV, NPV, and OA in detecting >or=50% stenosis of 96%, 100%, 100%, 100%, 58%, and 96%, respectively. An ICA PSV of >or=325 cm/s was optimal for >80% stenosis with a sensitivity of 100%, specificity of 99%, PPV of 100%, NPV of 88%, and OA of 99%. An ICA EDV of 119 cm/sec had sensitivity, specificity, PPV, NPV, and OA in detecting >or=80% stenosis of 99%, 100%, 100%, 100%, 75%, and 99%, respectively. The PSV of the stented artery was a better predictor for in-stent restenosis than the end-diastolic velocity or ICA/CCA ratio.
CONCLUSION
The optimal DUS velocity criteria for in-stent restenosis of >or=30%, >or=50%, and >or=80% were the PSVs of 154, 224, and 325 cm/s, respectively.
背景
用于确定支架内颈动脉再狭窄的最佳双功超声（DUS）速度标准存在争议。我们之前报道了支架内再狭窄≥30%时的最佳DUS速度。这项前瞻性研究将进一步明确检测不同严重程度支架内再狭窄（≥30%、≥50%以及80%至99%）时的最佳速度。
方法
分析纳入了144例作为临床试验一部分接受颈动脉支架置入术的患者。所有患者均完成了动脉造影，并在术后接受颈动脉DUS成像，术后1个月及之后每6个月重复检查。颈内动脉（ICA）收缩期峰值速度（PSV）≥130 cm/s的患者接受颈动脉计算机断层扫描（CT）/血管造影。记录ICA和颈总动脉（CCA）的PSV、舒张末期速度以及ICA/CCA比值的PSV。采用受试者操作特征曲线（ROC）分析来确定诊断≥30%、≥50%和≥80%再狭窄的最佳速度标准。
结果
平均随访时间为20个月（范围1 - 78个月）。可供分析的有215对成像（DUS与CTA/血管造影）研究。在22例患者的亚组中证实了CTA与颈动脉造影的准确性（kappa = 0.81）。ROC分析表明，ICA PSV≥154 cm/s对≥30%狭窄最为理想，敏感性为99%，特异性为89%，阳性预测值（PPV）为96%，阴性预测值（NPV）为97%，总体准确性（OA）为96%。ICA舒张末期速度（EDV）为42 cm/s时，检测≥30%狭窄的敏感性、特异性、PPV、NPV和OA分别为86%、62%、87%、60%和80%。ICA PSV≥224 cm/s对＞50%狭窄最为理想，敏感性为99%，特异性为90%，PPV为99%，NPV为90%，OA为98%。ICA EDV为88 cm/s时，检测≥50%狭窄的敏感性、特异性、PPV、NPV和OA分别为96%、100%、100%、100%、53%和96%。ICA/CCA比值为3.439时，检测≥50%狭窄的敏感性、特异性、PPV、NPV和OA分别为96%、100%、100%、100%、58%和96%。ICA PSV≥325 cm/s对＞80%狭窄最为理想，敏感性为100%，特异性为99%，PPV为100%，NPV为88%，OA为99%。ICA EDV为119 cm/sec时，检测≥80%狭窄的敏感性、特异性、PPV、NPV和OA分别为99%、100%、100%、100%、75%和99%。与舒张末期速度或ICA/CCA比值相比，支架置入动脉的PSV是支架内再狭窄更好的预测指标。
结论
支架内再狭窄≥30%、≥50%和≥80%时的最佳DUS速度标准分别为PSV 154、224和325 cm/s。
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