ABSTRACT
The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterectomy specimens to identify and quantitate atherosclerosis was compared in a five-center study. The carotid bifurcation in 900 patients was evaluated by angiography and ultrasound. In 216 cases, high-quality endarterectomy specimens were available for comparison with the preoperative images. All comparisons were made in a blinded fashion. Results indicate that ultrasound is able to differentiate angiographically normal from abnormal arteries with a sensitivity of 88% (1077 of 1233 arteries) and accuracy of 79% (1251 of 1578 arteries). Angiographic stenoses equal to or greater than 50% diameter were accurately identified by ultrasound imaging in 72% (1133 of 1578 arteries) of cases, and this was improved by the addition of other functional data (i.e., Doppler spectral analysis and oculoplethysmography). There was only modest correlation of absolute measurements of lesion width, minimal lumen, and standard lumen by the two imaging techniques (r = 0.28 to 0.55). Ultrasound measurements of lesion width were on the average 2 mm greater than those of angiography. The lumen averaged 1.5 mm larger when measured by ultrasound techniques. In the subset in which data were available from endarterectomy specimens, ultrasound showed the best correlation with lesion width (mean difference -1.1 mm) and angiography correlated best with minimal lumen (mean difference -0.1 mm). Neither examination consistently identified ulcerated plaques. Although ultrasound imaging alone has limited usefulness in quantitating luminal stenosis, this can be improved by the use of Doppler spectral analysis and oculoplethysmography. Ultrasound is superior to angiography for quantifying atherosclerotic plaque (lesion width) and will be an important tool for further study of atherosclerotic lesions.
Subject(s)
Angiography , Arteriosclerosis/diagnosis , Carotid Artery Diseases/diagnosis , Ultrasonography/methods , Adolescent , Adult , Aged , Aged, 80 and over , Arteriosclerosis/diagnostic imaging , Arteriosclerosis/pathology , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/pathology , Child , Clinical Trials as Topic , Endarterectomy , Female , Humans , Male , Middle AgedABSTRACT
Real-time ultrasonic imaging can provide useful clinical information in subjects with peripheral vascular disease. This report outlines the technique of imaging the extracranial arterial system and arterial segments that supply the lower extremities. It describes our interpretation of the ultrasonic image as it relates to the pathology of fatty streaks, smooth and complex plaques, occlusions and thrombus formations. Our experience consists of in excess of 2700 patients who were evaluated with real-time ultrasonic imaging in conjunction with noninvasive functional studies over 4 1/2 years. In our hands, real-time ultrasonic imaging performed in conjunction with functional noninvasive studies plays a more important role in the management of patients with cerebrovascular disease than in lower extremity vascular disease.
Subject(s)
Ultrasonography , Vascular Diseases/diagnosis , Arteriosclerosis/diagnosis , Carotid Artery Diseases/diagnosis , Female , Hemodynamics , Humans , Leg/blood supply , Male , Thrombosis/diagnosis , Vascular Diseases/surgeryABSTRACT
Noninvasive vascular laboratory evaluations were performed on 163 patients who presented with asymptomatic carotid bruits. Of these, 57 patients were identified as having a solely transmitted murmur. The remaining 106 patients had carotid disease. Based on hemodynamic criteria, 77 patients had compensated disease and 29 had uncompensated disease. These patients were followed for from 1 to 56 months (mean 31). Patients in the uncompensated group developed symptoms attributable to the extracranial territory at a higher rate than did patients in the compensated group, with differences continuing for 36 months. At 18 months the accumulated symptom rate for the uncompensated group (24.0%) was over twice that for the compensated group (11.4%). Patients in the uncompensated group also had a higher mortality rate. Differences occurred after 12 months and continued through 36 months. Of the 23 patients who died, 19 (82%) died due to cardiac disease, two due to cerebrovascular accidents, and two due to neoplastic disease. In view of the results of this study, a careful examination of patients with asymptomatic cervical bruits is warranted. This evaluation should take the form of a noninvasive vascular laboratory evaluation, which can help determine the proper course of patient management by measuring functional deficit and estimating anatomic severity.
