Fontenelle L J, Simper S C, Hanson T L
VA Medical Center, Biloxi, Mississippi.
Am Surg. 1994 Nov;60(11):864-8.
Angiography is presently felt to be the most accurate means of evaluating the carotid artery bifurcation, and is required preoperatively by most vascular surgeons. Arterial digital subtraction angiography (DSA) is the method commonly used. Angiography, however, is expensive and invasive, with significant morbidity and mortality. Duplex scanning (DS) has gained acceptance as a screening technique and has recently been advocated as the sole preoperative study in several centers because it is non-invasive and has an accuracy that is equal to or better than angiography. This study preoperatively evaluated 41 carotid arteries in 38 patients by arterial digital subtraction angiography and duplex scanning, and the results were compared to the surgical specimen. One artery was excluded because of an inadequate duplex scan, leaving 40 arteries studied by both techniques. Forty arteries (100%) studied by duplex scans corresponded with the surgical specimen, whereas only 31 arteries (77.5%) studied by DSA corresponded with the surgical specimen. Nine arteries (22.5%) studied by DSA had stenosis at the time of surgery significantly greater than predicted by DSA. Three arteries (7%) were felt to be normal by DSA, but had approximately 80 per cent stenosis by DS and at surgery. Our findings indicate that duplex scanning at our institution is more accurate than arterial DSA in determining percent diameter stenosis and plaque morphology of carotid arteries.
目前认为血管造影术是评估颈动脉分叉最准确的方法，大多数血管外科医生在术前都需要进行此项检查。动脉数字减影血管造影（DSA）是常用的方法。然而，血管造影术费用高昂且具有侵入性，存在显著的发病率和死亡率。双功扫描（DS）已被认可为一种筛查技术，最近在一些中心被提倡作为唯一的术前检查，因为它是非侵入性的，且准确性等同于或优于血管造影术。本研究通过动脉数字减影血管造影和双功扫描对38例患者的41条颈动脉进行了术前评估，并将结果与手术标本进行了比较。由于双功扫描不充分，一条动脉被排除，剩下40条动脉通过两种技术进行研究。通过双功扫描研究的40条动脉（100%）与手术标本相符，而通过DSA研究的只有31条动脉（77.5%）与手术标本相符。通过DSA研究的9条动脉（22.5%）在手术时的狭窄程度明显大于DSA预测的程度。有3条动脉（7%）DSA认为正常，但双功扫描和手术时显示约80%的狭窄。我们的研究结果表明，在我们机构，双功扫描在确定颈动脉直径狭窄百分比和斑块形态方面比动脉DSA更准确。
