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• W4250097997 abstract "We thank Drs. Alexandrov and Pullicino for their interesting comments relevant to our study. We did not compare a measurement of carotid artery stenosis based on comparing the residual internal carotid artery (ICA) diameter to the common carotid artery (CCA) diameter as defined by the Carotid Stenosis Index (CSI). 1Bladin CF Alexandrov AV Norris JW How should we measure carotid stenosis?.Lancet. 1994; 344 (Letter): 69Abstract PubMed Scopus (8) Google Scholar Our aim was to compare two commonly used duplex criteria with the two most commonly used methods of measuring angiographic stenosis (recently highlighted in the European Carotid Surgery Trial [ECST] 2European Carotid Surgery Trialists' Collaborative Group MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70% to 99%) or with mild (0% to 29%) carotid stenosis.Lancet. 1991; 337: 1235-1243Abstract PubMed Scopus (2977) Google Scholar and the North American Symptomatic Carotid Endarterectomy Trial [NASCET] 3North American Symptomatic Carotid Endarterectomy Trial Collaborators Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med. 1991; 325: 445-453Crossref PubMed Scopus (7402) Google Scholar) to assess in our unit how well the duplex and angiographic findings correlate. Seventy-five of 120 carotid bifurcations in our series (63%) showed stenosis ranging from 10% to 99% (not dissimilar to the 70% reported by Dr. Alexandrov 4Alexandrov AV Bladin CF Murphy J et al.Clinical applicability of methods to measure carotid stenosis.J Stroke Cerebrovasc Dis. 1994; 4: 258-261Abstract Full Text PDF Scopus (7) Google Scholar). We were surprised to find that in our series the duplex criteria based on Strandness et al. 5Strandness Jr, DE Duplex scanning in vascular disorders.in: Raven Press Ltd, New York1990: 92-120Google Scholar correlated better with the angiographic method as used in the NASCET, even though these criteria were originally developed with the angiographic measurement as used in the ECST. In keeping with the recommendations of the Committee on Standards for Non-invasive Vascular Testing of the Joint Council of the Society for Vascular Surgery and North American Chapter of the International Society for Cardiovascular Surgery, angiographic reporting in our unit has been based on measurement of ICA stenosis with reference to the distal ICA. With the use of selective digital subtraction angiography carotid catheterization and multiple views, obtaining a view of the ICA without attenuation from overlying vessels has not been a significant problem. Although the angiographic method used in the ECST has been reported to be more reproducible than that used in NASCET others have found NASCET to be more reproducible. It should be emphasized that the absolute differences (± SD) between observer measurements for both the NASCET and ECST methods of angiographic assessment in our series were small (3% ± 5.2% and 4.5% ± 6.3%, respectively), suggesting that the reproducibility of these methods is in fact very similar. It must also be remembered that neither measurement is a true representation of actual lumen area stenosis but represents a percent diameter stenosis as seen on the angiogram. Similarly, the recognized underestimation of true stenosis with use of the NASCET method must also be remembered. However, no difference has been reported between the NASCET, ECST, or CSI methods when used as a prognostic indicator of ipsilateral ischemic stroke. The prognostic value of each method is ultimately of greatest clinical interest. Because the indications for carotid endarterectomy are being better defined, there is a greater need for reliable methods of assessing ICA stenosis, and some uniformity of reporting standards seem desirable. The variability of measurements with duplex scanning between different laboratories and duplex scanners must, however, be emphasized. The duplex criteria used should be critically evaluated by individual units. The CSI may indeed prove to be a useful method of comparing duplex scanning and angiography. We look forward to seeing further results of this method of angiographic assessment." @default.
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