Farmilo R W, Scott D J, Cole S E, Jeans W D, Horrocks M
Department of Vascular Surgery, Bristol Royal Infirmary, UK.
Br J Surg. 1990 Apr;77(4):388-90. doi: 10.1002/bjs.1800770411.
A retrospective review of 63 patients undergoing duplex scanning and angiography for suspected carotid artery disease was performed to evaluate the need for routine angiography before carotid endarterectomy. A consultant surgeon (M.H.) made a simulated management decision on the basis of a clinical summary and a duplex scan report. Twenty-four patients were selected for surgery without angiography; duplex scanning had a sensitivity of 100 per cent and a specificity of 90 per cent in the detection of internal carotid artery stenosis. In two cases duplex scanning misdiagnosed a total occlusion as a critical stenosis. Eighteen patients failed to meet the criteria for surgery and were referred for angiography. Twenty-one patients were selected for conservative treatment on the basis of the duplex scan report. Combining the surgical and conservative groups (45 patients), duplex scanning had a sensitivity of 96 per cent and specificity of 95 per cent for the detection of stenosis greater than 50 per cent. In the identification of a total occlusion, duplex scanning had a poor sensitivity of 50 per cent. These results suggest that routine angiography before carotid endarterectomy is unnecessary in selected patients but that a suspected occlusion should be confirmed by angiography.
对63例因疑似颈动脉疾病而接受双功扫描和血管造影的患者进行了回顾性研究，以评估在颈动脉内膜切除术前行常规血管造影的必要性。一位外科顾问医生（M.H.）根据临床总结和双功扫描报告做出了模拟治疗决策。24例患者未进行血管造影即被选入手术组；双功扫描在检测颈内动脉狭窄方面的敏感性为100%，特异性为90%。在2例病例中，双功扫描将完全闭塞误诊为严重狭窄。18例患者不符合手术标准，被转诊进行血管造影。21例患者根据双功扫描报告被选入保守治疗组。将手术组和保守治疗组合并（共45例患者），双功扫描在检测大于50%的狭窄方面，敏感性为96%，特异性为95%。在识别完全闭塞方面，双功扫描的敏感性较差，为50%。这些结果表明，对于部分患者，在颈动脉内膜切除术前进行常规血管造影是不必要的，但疑似闭塞应由血管造影予以证实。
