Khaw K T
Department of Radiology, St George's Hospital, London, UK.
Br J Radiol. 1997 Mar;70:235-8. doi: 10.1259/bjr.70.831.9166045.
Carotid duplex imaging is now recognized as the best non-invasive screening test for carotid artery stenosis. The evidence for its use as the sole diagnostic imaging modality prior to carotid endarterectomy is examined. Providing it is carried out by experienced trained operators using validated duplex criteria, carotid duplex imaging is safe, highly sensitive and specific, and superior to angiography at plaque characterization and evaluation of flow disturbance. Cerebral CT or MRI should be performed if symptoms are atypical or if there is an evolved stroke. Angiography is required when duplex imaging is suboptimal or equivocal, in the presence of atypical symptoms or uncommon vascular abnormalities. In the majority of patients requiring endarterectomy for symptomatic high grade ICA stenosis, angiography seldom adds relevant information, and clinical assessment and carotid duplex imaging alone can be safely used in preoperative assessment.
颈动脉双功超声成像目前被认为是颈动脉狭窄最佳的非侵入性筛查检查。本文探讨了将其作为颈动脉内膜切除术之前唯一诊断成像方式的证据。如果由经验丰富、经过培训的操作人员使用经过验证的双功超声标准进行检查，颈动脉双功超声成像安全、高度敏感且具有特异性，在斑块特征描述和血流紊乱评估方面优于血管造影。如果症状不典型或出现进展性卒中，则应进行脑部CT或MRI检查。当双功超声成像效果欠佳或结果不明确、存在非典型症状或罕见血管异常时，需要进行血管造影。在大多数因症状性重度颈内动脉狭窄而需要进行内膜切除术的患者中，血管造影很少能提供相关信息，术前评估仅靠临床评估和颈动脉双功超声成像即可安全进行。
