颈动脉内膜切除术加补片血管成形术后确定颈内动脉狭窄≥50%和≥80%的双功超声标准。

Duplex criteria for determining ≥50% and ≥80% internal carotid artery stenosis following carotid endarterectomy with patch angioplasty.

作者信息

Aburahma Ali F

机构信息

Vascular Center of Excellence, Robert C Byrd Health Sciences Center, West Virginia University, 3110 MacCorkle Ave., SE, Charleston, WV 25304, USA.

出版信息

Vascular. 2011 Feb;19(1):15-20. doi: 10.1258/vasc.2010.oa0245.

DOI:10.1258/vasc.2010.oa0245

PMID:21489922

Abstract

The purpose of this study was to determine optimal velocities for detecting ≥50% and ≥80% restenosis prior to considering carotid intervention/carotid artery stenting (CAS) after carotid endarterectomy (CEA) with patching in symptomatic and asymptomatic patients. Two hundred CEA patients with 195 pairs of imaging (duplex ultrasound versus computed tomography angiography [CTA]/carotid arteriography) were analyzed. Peak systolic velocities (PSVs), end diastolic velocity (EDV) and internal carotid artery/common carotid artery (ICA/CCA) ratios were correlated to angiography. Receiver operator characteristic (ROC) curves determined optimal velocity criteria in detecting ≥50% and ≥80% restenosis. The mean PSVs for ≥50% and ≥80% restenosis were 248 and 404 c/s, respectively (P < 0.001). A PSV of ≥213 c/s was optimal for ≥50% restenosis with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of 99%, 100%, 100%, 98% and 99%, respectively. An ICA PSV of 274 c/s was optimal for ≥80% restenosis with sensitivity, specificity, PPV, NPV and OA of 100%, 91%, 99%, 100% and 99%, respectively. ROC analysis showed that PSVs were significantly better than EDVs and ICA/CCA ratios in detecting ≥50% restenosis. Standard duplex velocity criteria should be revised after CEA using patching. Specific carotid duplex velocities can be used to detect ≥50% and ≥80% restenosis after CEA with patch closure prior to carotid intervention/CAS.

摘要

本研究的目的是确定在有症状和无症状患者行颈动脉内膜切除术（CEA）并进行补片修补后，在考虑进行颈动脉干预/颈动脉支架置入术（CAS）之前，检测≥50%和≥80%再狭窄的最佳速度。对200例CEA患者的195对影像（双功超声与计算机断层血管造影[CTA]/颈动脉造影）进行了分析。将收缩期峰值速度（PSV）、舒张末期速度（EDV）和颈内动脉/颈总动脉（ICA/CCA）比值与血管造影结果进行关联。采用受试者操作特征（ROC）曲线确定检测≥50%和≥80%再狭窄的最佳速度标准。≥50%和≥80%再狭窄的平均PSV分别为248和404厘米/秒（P<0.001）。PSV≥213厘米/秒是检测≥50%再狭窄的最佳标准，其灵敏度、特异度、阳性预测值（PPV）、阴性预测值（NPV）和总体准确率（OA）分别为99%、100%、100%、98%和99%。颈内动脉PSV为274厘米/秒是检测≥80%再狭窄的最佳标准，其灵敏度、特异度、PPV、NPV和OA分别为100%、91%、99%、100%和99%。ROC分析表明，在检测≥50%再狭窄方面，PSV显著优于EDV和ICA/CCA比值。CEA使用补片修补后，应修订标准双功超声速度标准。特定的颈动脉双功超声速度可用于在颈动脉干预/CAS之前检测CEA补片闭合术后≥50%和≥80%的再狭窄。