Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, U Vojenské nemocnice 1200/2, Prague 6, 16000, Czech Republic.
Department of Pathology, Third Faculty of Medicine - Charles University, Prague, Czech Republic.
Acta Neurochir (Wien). 2022 Dec;164(12):3197-3202. doi: 10.1007/s00701-022-05332-5. Epub 2022 Aug 9.
DSA (digital subtraction angiography) is the gold standard for measuring carotid artery stenosis (CS). Yet, the correlation between DSA and stenosis is not well documented.
We compared CS as measured by DSA to carotid artery specimens obtained from carotid endarterectomy surgery. Patients were divided into three groups according to NASCET criteria (North American Symptomatic Carotid Endarterectomy Trial): stenosis of 30-49% (mild), stenosis of 50-69% (moderate), and stenosis of 70-99% (severe).
This prospective cohort study involved 644 patients. The mean stenosis in the mild stenosis group (n = 128 patients) was 54% ECST (European Carotid Surgery Trial), 40% NASCET, and 72% ESs (endarterectomy specimens). The mean absolute difference between ECST and NASCET was 14%. The mean stenosis in the moderate stenosis group (n = 347 patients) was 66% ECST, 60% NASCET, and 77% ES. The mean absolute difference between ECST and NASCET was 6%. The mean stenosis in the severe group (n = 169 patients) was 80% ECST, 76% NASCET, and 79% ES. No significant correlation coefficients were found between DSA and ES methods. In the mild group, the CC was 0.16 (ESCT) and 0.13 (NASCET); in the moderate group, the CC was 0.05 (ESCT) and 0.01 (NASCET); and in the severe group, the CC was 0.23 (ESCT) and 0.10 (NASCET). For all groups combined, CC was 0.22 for the ECST and 0.20 for the NASCET method.
The relationship between DSA and ES methods to measure CS is almost random. This lack of a relationship between the DSA and ES techniques questions the validity of current DSA-based guidelines.
DSA（数字减影血管造影）是测量颈动脉狭窄（CS）的金标准。然而，DSA 与狭窄之间的相关性尚未得到很好的记录。
我们将 DSA 测量的 CS 与颈动脉内膜切除术手术获得的颈动脉标本进行了比较。根据 NASCET 标准（北美症状性颈动脉内膜切除术试验），患者被分为三组：狭窄 30-49%（轻度）、狭窄 50-69%（中度）和狭窄 70-99%（重度）。
这项前瞻性队列研究共涉及 644 名患者。轻度狭窄组（n=128 例）的平均狭窄程度为 54%ECST（欧洲颈动脉手术试验）、40%NASCET 和 72%ES（内膜切除术标本）。ECST 和 NASCET 之间的平均绝对差异为 14%。中度狭窄组（n=347 例）的平均狭窄程度为 66%ECST、60%NASCET 和 77%ES。ECST 和 NASCET 之间的平均绝对差异为 6%。重度狭窄组（n=169 例）的平均狭窄程度为 80%ECST、76%NASCET 和 79%ES。未发现 DSA 和 ES 方法之间存在显著的相关系数。在轻度组中，CC 为 0.16（ESCT）和 0.13（NASCET）；在中度组中，CC 为 0.05（ESCT）和 0.01（NASCET）；在重度组中，CC 为 0.23（ESCT）和 0.10（NASCET）。对于所有合并组，ECST 的 CC 为 0.22，NASCET 方法的 CC 为 0.20。
DSA 和 ES 方法测量 CS 之间的关系几乎是随机的。DSA 和 ES 技术之间缺乏这种关系，这使得当前基于 DSA 的指南的有效性受到质疑。
