Overestimation of carotid stenosis on CTA - Real world experience
| Autor: | Yair Zlotnik, Gal Ifergane, Adi Goldbart, José E. Cohen, Michael Star, Vladimir Borodetsky, Anat Horev, Yotam Dizitzer, Ronen R. Leker, John M. Gomori, Ilan Shelef, Asaf Honig |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Computed Tomography Angiography medicine.medical_treatment Diagnostic accuracy Carotid endarterectomy 03 medical and health sciences 0302 clinical medicine Carotid angioplasty Predictive Value of Tests Physiology (medical) medicine Humans In patient Carotid Stenosis False Positive Reactions cardiovascular diseases Stroke Aged medicine.diagnostic_test business.industry musculoskeletal neural and ocular physiology Angiography Digital Subtraction General Medicine Digital subtraction angiography Middle Aged medicine.disease body regions Stenosis Neurology 030220 oncology & carcinogenesis Angiography Surgery Female Neurology (clinical) Radiology business psychological phenomena and processes 030217 neurology & neurosurgery |
| Zdroj: | Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 85 |
| ISSN: | 1532-2653 |
| Popis: | Background Symptomatic carotid stenosis is responsible for 10% of all strokes. Currently, CT angiography (CTA) is the main diagnostic tool for carotid stenosis. It is frequently the only diagnostic test preceding recommendations for carotid angioplasty and stenting (CAS) or carotid endarterectomy (CEA). However, the specificity of CTA, especially in patients with 50–70% stenosis, was previously reported to be relatively low. Most studies testing the diagnostic accuracy of CTA were published more than a decade ago. Therefore, we aimed to test the diagnostic accuracy of CTA, performed with current available technology, compared with digital subtraction angiography (DSA) in patients with carotid stenosis. This study aims to characterize patients who were candidates for CAS/CEA based on CTA, but may not require it based on DSA. Methods Consecutive candidates for carotid interventions (CAS or CEA) following CTA were identified from prospectively maintained stroke center registries at two large academic centers. As part of our institutional practice all patients had a routine pre-procedural diagnostic DSA. In each patient, degree of carotid stenosis was compared between CTA and DSA. Patients with concordant degree of stenosis on DSA and CTA (true positive group) were compared to patients with a discordant degree of stenosis with less than 50% on DSA (false positive group). Results Out of 90 patients with significant stenosis on CTA, only 70 (78%) were found to have a significant stenosis on DSA. Severe plaque calcification was significantly more common in the false-positive group. In those patients whose CTA reported stenosis of ≥90%, we found a strong agreement between CTA and DSA (positive predictive value [PPV] – 0.9) for a significant stenosis (≥50%). Conversely, the correlation between CTA and DSA in patients with CTA reported 50–70% stenosis was poor (PPV – 0.29) (p Conclusions Our results suggest that despite ongoing radiological progress, the specificity of CTA in accurately assessing carotid stenosis remains relatively low in patients with both moderate stenosis and heavily calcified plaques. Consequently, patients could possibly be referred for unnecessary CEA surgery and may become exposed to associated potential complications. |
| Databáze: | OpenAIRE |
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