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August 9, 2004

Evaluation of carotid stenosis using CT angiography in the initial evaluation of stroke and TIA

August 10, 2004 issue
63 (3) 457-460

Abstract

Background: Imaging of the carotid arteries is important for the evaluation of patients with ischemic stroke or TIA. CT angiography (CTA) of the head and neck is readily available and can be part of the routine imaging of stroke patients. To evaluate the accuracy of CTA, the authors compared the degree of stenosis found using CTA with digital subtraction angiography (DSA) in consecutive patients during a 3-year period.
Methods: The authors included all patients with interpretable CTA and DSA of the cervical carotid arteries from April 2000 to November 2002 at a single academic medical center. This yielded a total of 81 vessels. Stenosis on CTA of the internal carotid artery was measured in the axial plane at the point of maximum stenosis and referenced to the distal cervical internal carotid by two blinded readers. Two blinded readers measured stenosis from the DSA using the North American Symptomatic Carotid Endarterectomy Trial method.
Results: Using a 70% cutoff value for stenosis, CTA and DSA were in agreement in 78 of 81 (96%; 95% CI, 90 to 99%) vessels. CTA was 100% sensitive (n = 5) and 63% specific (95% CI, 25 to 88%), and the negative predictive value of a CTA demonstrating <70% stenosis was 100% (n = 73).
Conclusions: In this consecutive series of patients with CT angiography of the neck and digital subtraction angiography, the authors found that CT angiography has a high sensitivity and high negative predictive value for carotid disease. CT angiography appears to be an excellent screening test for internal carotid artery stenosis, and the authors advocate its use for the initial imaging of patients with suspected stroke or TIA.

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References

1.
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991; 325: 445–453.
2.
Johnston SC. Clinical practice. Transient ischemic attack. N Engl J Med. 2002; 347: 1687–1692.
3.
Albers GW, Hart RG, Lutsep HL, Newell DW, Sacco RL. AHA Scientific Statement. Supplement to the guidelines for the management of transient ischemic attacks: a statement from the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks, Stroke Council, American Heart Association. Stroke. 1999; 30: 2502–2511.
4.
Hankey GJ, Warlow CP, Sellar RJ. Cerebral angiographic risk in mild cerebrovascular disease. Stroke. 1990; 21: 209–222.
5.
Culebras A, Kase CS, Masdeu JC, et al. Practice guidelines for the use of imaging in transient ischemic attacks and acute stroke. A report of the Stroke Council, American Heart Association. Stroke. 1997; 28: 1480–1497.
6.
Smith WS, Roberts HC, Chuang NA, et al. Safety and feasibility of a CT protocol for acute stroke: combined CT, CT angiography, and CT perfusion imaging in 53 consecutive patients. AJNR Am J Neuroradiol. 2003; 24: 688–690.
7.
Roberts HC, Roberts TP, Smith WS, Lee TJ, Fischbein NJ, Dillon WP. Multisection dynamic CT perfusion for acute cerebral ischemia: the “toggling-table” technique. AJNR Am J Neuroradiol. 2001; 22: 1077–1080.
8.
Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics. 1977; 33: 363–374.
9.
Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998; 339: 1415–1425.
10.
Alvarez-Linera J, Benito-Leon J, Escribano J, Campollo J, Gesto R. Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. AJNR Am J Neuroradiol. 2003; 24: 1012–1019.
11.
Patel SG, Collie DA, Wardlaw JM, et al. Outcome, observe reliability, and patient preferences if CTA, MRA, or Doppler ultrasound were used, individually or together, instead of digital subtraction angiography before carotid endarterectomy. J Neurol Neurosurg Psychiatry. 2002; 73: 21–28.
12.
Anderson GB, Ashforth R, Steinke DE, Ferdinandy R, Findlay JM. CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke. 2000; 31: 2168–2174.
13.
De Monti M, Ghilardi G, Caverni L, et al. Multidetector helical angio CT oblique reconstructions orthogonal to internal carotid artery for preoperative evaluation of stenosis: a prospective study of comparison with color Doppler US, digital subtraction angiography and intraoperative data. Minerva Cardioangiol. 2003; 51: 373–385.
14.
Pan XM, Saloner D, Reilly LM, et al. Assessment of carotid artery stenosis by ultrasonography, conventional angiography, and magnetic resonance angiography: correlation with ex vivo measurement of plaque stenosis. J Vasc Surg. 1995; 21: 82–88.
15.
Powers WJ. Carotid arteriography: still golden after all these years? Neurology. 2004; 62: 1246–1247.
16.
Chang YJ, Ryu SJ, Lin SK. Carotid artery stenosis in ischemic stroke patients with nonvalvular atrial fibrillation. Cerebrovasc Dis. 2002; 13: 16–20.
17.
Kennedy J, Hill MD, Eliasziw M, Buchan AM, Barnett HJ. Short-term prognosis following acute cerebral ischemia. Stroke. 2002; 33: 382.

Information & Authors

Information

Published In

Neurology®
Volume 63Number 3August 10, 2004
Pages: 457-460
PubMed: 15304575

Publication History

Received: December 29, 2003
Accepted: May 25, 2004
Published online: August 9, 2004
Published in print: August 10, 2004

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Authors

Affiliations & Disclosures

S. A. Josephson, MD
From the Departments of Neurology (Drs. Josephson, Johnston, and Smith) and Radiology (Drs. Bryant and Dillon), University of California, San Francisco, CA; and Department of Diagnostic Radiology (Dr. Mak), Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region.
S. O. Bryant, MD
From the Departments of Neurology (Drs. Josephson, Johnston, and Smith) and Radiology (Drs. Bryant and Dillon), University of California, San Francisco, CA; and Department of Diagnostic Radiology (Dr. Mak), Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region.
H. K. Mak, MD
From the Departments of Neurology (Drs. Josephson, Johnston, and Smith) and Radiology (Drs. Bryant and Dillon), University of California, San Francisco, CA; and Department of Diagnostic Radiology (Dr. Mak), Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region.
S. C. Johnston, MD PhD
From the Departments of Neurology (Drs. Josephson, Johnston, and Smith) and Radiology (Drs. Bryant and Dillon), University of California, San Francisco, CA; and Department of Diagnostic Radiology (Dr. Mak), Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region.
W. P. Dillon, MD
From the Departments of Neurology (Drs. Josephson, Johnston, and Smith) and Radiology (Drs. Bryant and Dillon), University of California, San Francisco, CA; and Department of Diagnostic Radiology (Dr. Mak), Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region.
W. S. Smith, MD PhD
From the Departments of Neurology (Drs. Josephson, Johnston, and Smith) and Radiology (Drs. Bryant and Dillon), University of California, San Francisco, CA; and Department of Diagnostic Radiology (Dr. Mak), Yan Chai Hospital, Tsuen Wan, Hong Kong Special Administrative Region.

Notes

Address correspondence and reprint requests to Dr. Wade S. Smith, Department of Neurology, 505 Parnassus Avenue, San Francisco, CA 94143-0114; e-mail: [email protected]

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