Rothwell P M, Gibson R J, Slattery J, Warlow C P
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, Scotland.
Stroke. 1994 Dec;25(12):2440-4. doi: 10.1161/01.str.25.12.2440.
The use of three methods of measuring carotid stenosis, which produce different values on the same angiograms, has caused confusion and reduced the generalizability of the results of research. If the results of future studies are to be properly applied to clinical practice, and if noninvasive methods of imaging are to be properly validated against angiography, a single, standard method of measurement of stenosis on angiograms must be adopted. This standard method should be selected on the bases of its ability to predict risk of ipsilateral carotid distribution ischemic stroke and its reproducibility.
The method of measurement of carotid stenosis used in the European Carotid Surgery Trial (ECST), that used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and a method based on the measurement of the common carotid (CC) lumen diameter were studied. Their use in the prediction of ipsilateral carotid distribution ischemic stroke was assessed in 1001 consecutively selected patients randomly assigned to medical treatment in the ECST. Carotid stenosis was measured by two observers working independently, using all three methods, on the angiographic view that showed the most severe stenosis of the symptomatic carotid bifurcation. Interobserver agreement was determined, and 50 angiograms were remeasured to determine intraobserver agreement.
There was little difference in the ability of the three methods to predict ipsilateral carotid distribution ischemic stroke. The CC method was consistently the most reproducible of the three, particularly for stenosis in the clinically important range of 50% to 90%.
The CC method of measurement should be adopted as the standard method of measuring the degree of carotid stenosis on angiograms.
三种测量颈动脉狭窄的方法在同一血管造影片上得出不同数值，这造成了混乱并降低了研究结果的可推广性。若要将未来研究结果恰当应用于临床实践，以及若要针对血管造影对非侵入性成像方法进行恰当验证，必须采用一种单一的、标准的血管造影片上狭窄测量方法。应基于其预测同侧颈动脉分布区缺血性卒中风险的能力及其可重复性来选择这种标准方法。
对欧洲颈动脉外科试验（ECST）中使用的颈动脉狭窄测量方法、北美症状性颈动脉内膜切除术试验（NASCET）中使用的方法以及一种基于颈总动脉（CC）管腔直径测量的方法进行了研究。在ECST中连续入选的1001例随机分配接受药物治疗的患者中，评估了这些方法在预测同侧颈动脉分布区缺血性卒中方面的应用情况。由两名独立工作的观察者使用所有三种方法，在显示症状性颈动脉分叉处最严重狭窄的血管造影视图上测量颈动脉狭窄。确定了观察者间的一致性，并重新测量了50张血管造影片以确定观察者内的一致性。
三种方法在预测同侧颈动脉分布区缺血性卒中的能力方面差异不大。CC方法始终是三种方法中可重复性最强的，特别是对于50%至90%这一临床重要范围内的狭窄。
应采用CC测量方法作为血管造影片上测量颈动脉狭窄程度的标准方法。
