Abstract:
OBJECTIVE:To determine the influence of all possible imaging strategies on the appropriateness ratings for carotid endarterectomy, because less accurate noninvasive techniques are replacing contrast angiography, which was used in the major efficacy trials. METHODS:An expert panel, using appropriateness methodology, rated 203 scenarios where endarterectomy might be performed. Each scenario was rated where internal carotid artery stenosis was determined using five different imaging sources: 1) conventional angiography, 2) ultrasound carotid Doppler only, 3) CT (CTA) or MR (MRA) angiography only, 4) concordant results from two noninvasive carotid imaging studies, and 5) discordant results from two noninvasive studies. The scenarios deemed appropriate by conventional angiography were identified. The effect of the other imaging modalities on these results was examined. RESULTS:Thirty-three scenarios were identified as being appropriate. Concordant imaging results had no effect on appropriateness ratings in symptomatic carotid artery disease when compared with conventional angiography. Single noninvasive imaging techniques were deemed appropriate for investigation only in the presence of severe symptomatic stenosis. In all other scenarios, single noninvasive imaging and discordant results reduced the appropriateness rating of scenarios to either uncertain benefit or inappropriateness. The single appropriate scenario for asymptomatic carotid artery stenosis was where severe stenosis was determined by concordant noninvasive imaging or by CTA or MRA alone. CONCLUSION:It is important to take into account both the clinical scenario and the imaging modalities utilized to determine the degree of internal carotid artery stenosis in the clinical decision making surrounding carotid endarterectomy.
journal_name
Neurologyjournal_title
Neurologyauthors
Kennedy J,Quan H,Ghali WA,Feasby TEdoi
10.1212/01.wnl.0000115097.61748.bfsubject
Has Abstractpub_date
2004-03-23 00:00:00pages
901-4issue
6eissn
0028-3878issn
1526-632Xjournal_volume
62pub_type
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