The relative contributions of carotid duplex scanning, magnetic resonance angiography, and cerebral arteriography to clinical decisionmaking

A prospective study in patients with carotid occlusive disease

L. S. Erdoes, J. M. Marek, Joseph L Mills, S. S. Berman, T. Whitehill, G. C. Hunter, W. Feinberg, W. Krupski

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Purpose: Recent reports suggest that 80% to 90% of patients can safely undergo carotid endarterectomy on the basis of duplex scanning alone without cerebral angiography. Other investigators have recommended that a complementary imaging study such as magnetic resonance angiography (MRA) also be obtained. Methods: We prospectively evaluated 103 consecutive patients with carotid occlusive disease. Eighty percent of patients were symptomatic. All 103 patients underwent duplex scanning and arteriography. Additional noninvasive tests included computed tomography, magnetic resonance imaging, and MRA in 50%, 56%, and 48% of patients, respectively. At a multispecialty conference all studies except angiograms were reviewed, and a treatment decision was made by a panel of attending vascular surgeons, neurosurgeons, and neurologists. The cerebral angiograms then were reviewed and changes made to final treatment plans were noted. Results: After review of noninvasive studies, 30 of 103 of patients (29%) were believed to require arteriography because of diagnostic uncertainty of carotid occlusion in three patients, suggestion of nonatherosclerotic disease in four, suggestion of proximal disease in two, suboptimal noninvasive studies in one, and uncertainty of therapy despite good-quality noninvasive studies in 20 patients primarily with borderline stenoses and unclear symptoms. In 10 of these 30 patients (33%) management decisions were changed on the basis of angiogram results. Of the remaining 73 patients (71%) in whom the panel felt comfortable proceeding with operative or medical therapy without angiography, only one patient (1.4%) would have bad management altered by results of angiography. MRA results concurred with duplex findings in 92% of studies, but did not alter management in any patient. Conclusions: In patients with good-quality duplex images, focal atherosclerotic bifurcation disease, and clear clinical presentation, treatment decisions can be made without arteriography. In 30% of patients angiography is useful in clarifying decision making. MRA is unlikely to influence management decisions and is thus rarely indicated.

Original languageEnglish (US)
Pages (from-to)950-956
Number of pages7
JournalJournal of Vascular Surgery
Volume23
Issue number5
DOIs
StatePublished - 1996

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Magnetic Resonance Angiography
Angiography
Prospective Studies
Uncertainty
Therapeutics
Cerebral Angiography
Carotid Endarterectomy
Blood Vessels
Decision Making
Pathologic Constriction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

The relative contributions of carotid duplex scanning, magnetic resonance angiography, and cerebral arteriography to clinical decisionmaking : A prospective study in patients with carotid occlusive disease. / Erdoes, L. S.; Marek, J. M.; Mills, Joseph L; Berman, S. S.; Whitehill, T.; Hunter, G. C.; Feinberg, W.; Krupski, W.

In: Journal of Vascular Surgery, Vol. 23, No. 5, 1996, p. 950-956.

Research output: Contribution to journalArticle

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title = "The relative contributions of carotid duplex scanning, magnetic resonance angiography, and cerebral arteriography to clinical decisionmaking: A prospective study in patients with carotid occlusive disease",
abstract = "Purpose: Recent reports suggest that 80{\%} to 90{\%} of patients can safely undergo carotid endarterectomy on the basis of duplex scanning alone without cerebral angiography. Other investigators have recommended that a complementary imaging study such as magnetic resonance angiography (MRA) also be obtained. Methods: We prospectively evaluated 103 consecutive patients with carotid occlusive disease. Eighty percent of patients were symptomatic. All 103 patients underwent duplex scanning and arteriography. Additional noninvasive tests included computed tomography, magnetic resonance imaging, and MRA in 50{\%}, 56{\%}, and 48{\%} of patients, respectively. At a multispecialty conference all studies except angiograms were reviewed, and a treatment decision was made by a panel of attending vascular surgeons, neurosurgeons, and neurologists. The cerebral angiograms then were reviewed and changes made to final treatment plans were noted. Results: After review of noninvasive studies, 30 of 103 of patients (29{\%}) were believed to require arteriography because of diagnostic uncertainty of carotid occlusion in three patients, suggestion of nonatherosclerotic disease in four, suggestion of proximal disease in two, suboptimal noninvasive studies in one, and uncertainty of therapy despite good-quality noninvasive studies in 20 patients primarily with borderline stenoses and unclear symptoms. In 10 of these 30 patients (33{\%}) management decisions were changed on the basis of angiogram results. Of the remaining 73 patients (71{\%}) in whom the panel felt comfortable proceeding with operative or medical therapy without angiography, only one patient (1.4{\%}) would have bad management altered by results of angiography. MRA results concurred with duplex findings in 92{\%} of studies, but did not alter management in any patient. Conclusions: In patients with good-quality duplex images, focal atherosclerotic bifurcation disease, and clear clinical presentation, treatment decisions can be made without arteriography. In 30{\%} of patients angiography is useful in clarifying decision making. MRA is unlikely to influence management decisions and is thus rarely indicated.",
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T1 - The relative contributions of carotid duplex scanning, magnetic resonance angiography, and cerebral arteriography to clinical decisionmaking

T2 - A prospective study in patients with carotid occlusive disease

AU - Erdoes, L. S.

AU - Marek, J. M.

AU - Mills, Joseph L

AU - Berman, S. S.

AU - Whitehill, T.

AU - Hunter, G. C.

AU - Feinberg, W.

AU - Krupski, W.

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N2 - Purpose: Recent reports suggest that 80% to 90% of patients can safely undergo carotid endarterectomy on the basis of duplex scanning alone without cerebral angiography. Other investigators have recommended that a complementary imaging study such as magnetic resonance angiography (MRA) also be obtained. Methods: We prospectively evaluated 103 consecutive patients with carotid occlusive disease. Eighty percent of patients were symptomatic. All 103 patients underwent duplex scanning and arteriography. Additional noninvasive tests included computed tomography, magnetic resonance imaging, and MRA in 50%, 56%, and 48% of patients, respectively. At a multispecialty conference all studies except angiograms were reviewed, and a treatment decision was made by a panel of attending vascular surgeons, neurosurgeons, and neurologists. The cerebral angiograms then were reviewed and changes made to final treatment plans were noted. Results: After review of noninvasive studies, 30 of 103 of patients (29%) were believed to require arteriography because of diagnostic uncertainty of carotid occlusion in three patients, suggestion of nonatherosclerotic disease in four, suggestion of proximal disease in two, suboptimal noninvasive studies in one, and uncertainty of therapy despite good-quality noninvasive studies in 20 patients primarily with borderline stenoses and unclear symptoms. In 10 of these 30 patients (33%) management decisions were changed on the basis of angiogram results. Of the remaining 73 patients (71%) in whom the panel felt comfortable proceeding with operative or medical therapy without angiography, only one patient (1.4%) would have bad management altered by results of angiography. MRA results concurred with duplex findings in 92% of studies, but did not alter management in any patient. Conclusions: In patients with good-quality duplex images, focal atherosclerotic bifurcation disease, and clear clinical presentation, treatment decisions can be made without arteriography. In 30% of patients angiography is useful in clarifying decision making. MRA is unlikely to influence management decisions and is thus rarely indicated.

AB - Purpose: Recent reports suggest that 80% to 90% of patients can safely undergo carotid endarterectomy on the basis of duplex scanning alone without cerebral angiography. Other investigators have recommended that a complementary imaging study such as magnetic resonance angiography (MRA) also be obtained. Methods: We prospectively evaluated 103 consecutive patients with carotid occlusive disease. Eighty percent of patients were symptomatic. All 103 patients underwent duplex scanning and arteriography. Additional noninvasive tests included computed tomography, magnetic resonance imaging, and MRA in 50%, 56%, and 48% of patients, respectively. At a multispecialty conference all studies except angiograms were reviewed, and a treatment decision was made by a panel of attending vascular surgeons, neurosurgeons, and neurologists. The cerebral angiograms then were reviewed and changes made to final treatment plans were noted. Results: After review of noninvasive studies, 30 of 103 of patients (29%) were believed to require arteriography because of diagnostic uncertainty of carotid occlusion in three patients, suggestion of nonatherosclerotic disease in four, suggestion of proximal disease in two, suboptimal noninvasive studies in one, and uncertainty of therapy despite good-quality noninvasive studies in 20 patients primarily with borderline stenoses and unclear symptoms. In 10 of these 30 patients (33%) management decisions were changed on the basis of angiogram results. Of the remaining 73 patients (71%) in whom the panel felt comfortable proceeding with operative or medical therapy without angiography, only one patient (1.4%) would have bad management altered by results of angiography. MRA results concurred with duplex findings in 92% of studies, but did not alter management in any patient. Conclusions: In patients with good-quality duplex images, focal atherosclerotic bifurcation disease, and clear clinical presentation, treatment decisions can be made without arteriography. In 30% of patients angiography is useful in clarifying decision making. MRA is unlikely to influence management decisions and is thus rarely indicated.

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