Strosberg David S, Haurani Mounir J, Satiani Bhagwan, Go Michael R
Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Vasc Surg. 2017 Jul;66(1):226-231. doi: 10.1016/j.jvs.2017.01.041. Epub 2017 Apr 5.
Whereas duplex ultrasound parameters for predicting internal carotid artery (ICA) stenosis are well defined, the use of common carotid artery (CCA) Doppler characteristics to predict ICA stenosis when the ICA cannot be insonated directly or accurately because of anatomy, calcification, or tortuosity has not been studied. The objective of this study was to identify CCA Doppler parameters that may predict ICA stenosis.
We reviewed all patients at our institution who underwent carotid duplex ultrasound (CDU) from 2008 to 2015 and also had a comparison computed tomography, magnetic resonance, or catheter angiogram. We excluded patients whose CDU examination did not correlate with the comparison study, those whose arteries were not visualized on the comparison study, and those with complete occlusion of the CCA. We collected CCA peak systolic velocity (PSV), end-diastolic velocity (EDV), and acceleration time (AT) in addition to CDU and comparison imaging interpretation of degree of stenosis. A multivariate model was used to identify predictors of ICA stenosis.
There were 99 CDU examinations with corresponding comparison imaging included. For every increase of 10 cm/s in EDV in the CCA, the odds of a >50% ICA stenosis being present vs a ≤50% ICA stenosis decreased by 37% (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.41-0.97; P = .03). For every increase of 10 cm/s in EDV in the CCA, the odds of a 70% to 99% ICA stenosis being present vs a ≤50% ICA stenosis decreased by 48% (OR, 0.52; 95% CI, 0.28-0.94; P = .03). A CCA EDV of 19 cm/s or below was associated with a 64% probability of a 70% to 99% ICA stenosis. For every 50-millisecond increase in AT in the CCA, the odds of a >50% stenosis being present vs a ≤50% ICA stenosis increased by 56% (OR, 1.56; 95% CI, 1.03-2.35; P = .04). A CCA AT of 80 milliseconds or above was associated with a 69% probability of a >50% ICA stenosis. There was no correlation between CCA PSV and ICA stenosis.
CCA EDV and AT are independent predictors of ICA stenosis and may be used in the setting of patients whose ICA cannot be directly insonated or when standard duplex ultrasound parameters of ICA PSV, EDV, or ICA/CCA ratio conflict.
虽然用于预测颈内动脉（ICA）狭窄的双功超声参数已得到明确界定，但当由于解剖结构、钙化或迂曲等原因无法直接或准确地对ICA进行超声检查时，利用颈总动脉（CCA）多普勒特征来预测ICA狭窄的情况尚未得到研究。本研究的目的是确定可能预测ICA狭窄的CCA多普勒参数。
我们回顾了2008年至2015年在我院接受颈动脉双功超声（CDU）检查且同时进行了对比计算机断层扫描、磁共振成像或导管血管造影的所有患者。我们排除了CDU检查结果与对比研究不相关的患者、对比研究中动脉未显影的患者以及CCA完全闭塞的患者。除了收集CDU和对比成像对狭窄程度的解读外，我们还收集了CCA的峰值收缩速度（PSV）、舒张末期速度（EDV）和加速时间（AT）。使用多变量模型来确定ICA狭窄的预测因素。
共有99次CDU检查并伴有相应的对比成像。CCA的EDV每增加10 cm/s，ICA狭窄＞50%与ICA狭窄≤50%相比的几率降低37%（比值比[OR]，0.63；95%置信区间[CI]，0.41 - 0.97；P = 0.03）。CCA的EDV每增加10 cm/s，ICA狭窄70%至99%与ICA狭窄≤50%相比的几率降低48%（OR，0.52；95% CI，0.28 - 0.94；P = 0.03）。CCA的EDV为19 cm/s或更低与ICA狭窄70%至99%的概率为64%相关。CCA的AT每增加50毫秒，ICA狭窄＞50%与ICA狭窄≤50%相比的几率增加56%（OR，1.56；95% CI，1.03 - 2.35；P = 0.04）。CCA的AT为80毫秒或更高与ICA狭窄＞50%的概率为69%相关。CCA的PSV与ICA狭窄之间无相关性。
CCA的EDV和AT是ICA狭窄的独立预测因素，可用于无法直接对ICA进行超声检查的患者，或当ICA的PSV、EDV或ICA/CCA比值等标准双功超声参数出现矛盾的情况。
