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首页> 外文期刊>Vascular and endovascular surgery >Are we undertreating carotid stenoses diagnosed by ultrasound alone?
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Are we undertreating carotid stenoses diagnosed by ultrasound alone?

机译：我们是否仅通过超声就可以治疗颈动脉狭窄？

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Clinical management of carotid disease is primarily based on results of national trials (ACAS and NASCET) that used the distal internal carotid artery diameter as a reference. However, commonly accepted ultrasound (US) criteria for carotid stenosis were derived from the correlation of velocity measurements with angiographic bulb diameter reductions (BDR). This study was undertaken to compare the degree of carotid stenosis determined by conventional velocity criteria to the degree of stenosis measured by B-mode (gray scale) diameter at both the carotid bulb and at the distal internal carotid artery, and, second, to evaluate US imaging to derive distal diameter reductions (DDR) noninvasively. During a 3-month period patients referred for carotid US were prospectively analyzed for standard velocity criteria and plaque morphology. Minimum carotid diameter was measured by longitudinal and transverse B-mode measurements and compared to carotid bulb diameter and internal carotid diameter distal to all disease. B-mode diameter reductions were compared to the degree of stenosis determined by velocity criteria and to patient symptoms and the decision for carotid endarterectomy. In total, 131 carotid arteries in 74 patients were evaluated. Based on the University of Washington velocity criteria, lesions were classified as grade I (n = 61, 46%), IIA (n = 58, 44%), IIB (n = 7, 5%), or III (n = 5, 4%). BDR measured by B-mode predicted the grade of disease based on velocity criteria (p < 0.001) with an overall accuracy of 95%. With use of the B-mode for DDR (NASCET style), 18 patients exceeded the 60% threshold for surgical intervention. Of these, only 3 patients were symptomatic and were operated on. An additional 3 operated-on patients had an asymptomatic grade III stenosis, our usual threshold for intervention. Twelve additional patients were appropriate for surgical intervention by B-mode but were not treated based on conventional velocity criteria alone. Bulb diameter reduction by B-mode imaging correlates strongly with diameter reduction determined by velocity criteria, and independently predicts the grade of carotid disease. With this in mind, the accuracy of B-mode imaging may be extended to the measurement of carotid stenosis based on DDR. By B-mode criteria, many patients appropriate for intervention were not offered treatment based on conventional velocity criteria. Modern B-mode imaging provides a noninvasive method to obtain 'arteriographic equivalent'' measurements and should be added as a routine to carotid ultrasound interrogation.
机译：颈动脉疾病的临床管理主要基于国家临床试验（ACAS和NASCET）的结果，该研究使用了颈内动脉远端直径作为参考。然而，颈动脉狭窄的公认超声（US）标准是由速度测量值与血管造影球直径减小（BDR）的相关性得出的。进行这项研究的目的是比较常规速度标准所确定的颈动脉狭窄程度与颈动脉球和颈内远端动脉的B型（灰度）直径所测量的狭窄程度，然后进行评估通过US成像以非侵入方式获得远端直径缩小（DDR）。在三个月的时间里，对接受颈动脉超声检查的患者进行了前瞻性分析，以了解标准的速度标准和斑块形态。通过纵向和横向B型测量测量最小颈动脉直径，并将其与所有疾病远端的颈动脉球直径和内部颈动脉直径进行比较。将B型直径的减小与通过速度标准确定的狭窄程度，患者症状以及颈动脉内膜切除术的决定进行比较。总共评估了74例患者的131个颈动脉。根据华盛顿大学的速度标准，病变分为I级（n = 61，46％），IIA（n = 58，44％），IIB（n = 7、5％）或III（n = 5） ，4％）。 B模式测量的BDR根据速度标准（p <0.001）预测疾病等级，总体准确度为95％。通过将B模式用于DDR（NASCET类型），有18名患者超过了60％的手术干预阈值。其中，只有3例有症状并接受手术。另外3名接受手术的患者出现无症状的III级狭窄，这是我们通常的干预阈值。另外十二名患者适合通过B型进行手术干预，但没有单独根据常规速度标准进行治疗。通过B型成像缩小灯泡直径与根据速度标准确定的直径缩小高度相关，并独立预测颈动脉疾病的程度。考虑到这一点，B模式成像的准确性可以扩展到基于DDR的颈动脉狭窄的测量。根据B型标准，许多适合介入治疗的患者未根据常规速度标准获得治疗。现代的B模式成像提供了一种无创的方法来获得“动脉造影等效”测量值，应作为常规程序添加到颈动脉超声检查中。

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