血管造影术评估颈内动脉狭窄的方法对颈动脉手术指征的影响。

Influence of the angiographic internal carotid artery stenosis assessment method on indicating carotid surgery.

作者信息

Müller M, Bartylla K, Rolshausen A, Piepgras U, Schimrigk K

机构信息

Department of Neurology, University Hospital of the Saarland, Homburg/Saar, Germany.

出版信息

Vasa. 1998 Feb;27(1):24-8.

PMID:9540429

Abstract

BACKGROUND

To estimate the influence of different kinds of angiographic internal carotid artery (ICA) stenosis assessment methods on clinical decision making on carotid surgery.

METHOD

One hundred angiographically proven ICA lesions in 65 patients (54 men, 11 women, mean age +/- SD, 64 +/- 8 years) were evaluated by simultaneous biplane angiography. The angiograms were analyzed using three kinds of linear diameter reduction methods [North American (NASCET), and European (ECST) carotid surgery trial method, common carotid artery method (CC)], and five area reduction methods reflecting more accurately the anatomical degree of stenosis [squared NASCET, ECST and CC (N2, E2, CC2), combined stenosis estimation of two projections (NASCET-bi, ECST-bi)]. All lesions were additionally evaluated by continuous wave (cw-)Doppler ultrasound prior to angiography. Between method agreement on classifying the lesions into stenosis < 70% and into stenosis > or = 70% was calculated by means of kappa statistic.

RESULTS

The degree of stenosis (median and inter-quartile range) ranged between 65% (38-82) by means of NASCET and 91% (87-93) by means of CC2. Thirty-seven ICA stenoses would have been operated on using NASCET, but 82 using CC2. Between method agreement on assessing high grade ICA stenosis ranged from poor (kappa value 0.17 for the pair NASCET/CC2) to excellent (kappa value 0.92 for the pair N2/NASCET-bi). Cw-Doppler ultrasound showed a good agreement (kappa value 0.72-0.80) with all angiographic methods using an area reduction formula apart from CC2. The agreement was moderate between cw-Doppler and NASCET and ECST, respectively.

CONCLUSION

The clinical decision to operate on an ICA stenosis will strongly be influenced by the angiographic method used. Because reliable clinical data exist only for the NASCET and ECST method these two angiographic stenosis assessment method should be used for clinical decision making.

摘要

背景

评估不同类型的血管造影术评估颈内动脉（ICA）狭窄方法对颈动脉手术临床决策的影响。

方法

通过同步双平面血管造影术对65例患者（54例男性，11例女性，平均年龄±标准差，64±8岁）的100处经血管造影证实的ICA病变进行评估。使用三种线性直径缩减方法[北美（NASCET）和欧洲（ECST）颈动脉手术试验方法、颈总动脉方法（CC）]以及五种更准确反映狭窄解剖程度的面积缩减方法[平方NASCET、ECST和CC（N2、E2、CC2）、两个投影的联合狭窄估计（NASCET-bi、ECST-bi）]对血管造影片进行分析。所有病变在血管造影术前均通过连续波（cw-）多普勒超声进行额外评估。通过kappa统计量计算不同方法在将病变分类为狭窄<70%和狭窄≥70%方面的一致性。

结果

狭窄程度（中位数和四分位间距）通过NASCET法为65%（38 - 82），通过CC2法为91%（87 - 93）。使用NASCET法时37处ICA狭窄会进行手术，但使用CC2法时为82处。不同方法在评估高度ICA狭窄方面的一致性从较差（NASCET/CC2组的kappa值为0.17）到极好（N2/NASCET-bi组的kappa值为0.92）不等。除CC2外，cw-多普勒超声与所有使用面积缩减公式的血管造影方法显示出良好的一致性（kappa值0.72 - 0.80）。cw-多普勒与NASCET和ECST之间的一致性分别为中等。