For proving, the diagnosis DSA was performed as a gold standard protocol, only in patients with suspected carotid artery stenosis ≥ 50% based on CTA and DUS.Ī Toshiba Core-Vision pro with a linear array multifrequency transducer (5 - 10 MHz), an additional convex transducer for imaging of the carotid artery, and another phased array transducer (2 - 3.5 MHz) were used for Doppler sonography of the carotid artery. These patients were examined prospectively by DUS and CT-angiography. All of the patients were informed about all the examination procedures and data analyzing. The study protocol conformed to the ethical guidelines of the 1975 declaration of Helsinki. The aim of this study was to evaluate the usefulness and accuracy of the non-invasive DS and CTA, attempting in this way to restrict DSA only for final proof of high-grade stenosis.Ģ5 male patients suspected to have a carotid artery stenosis lesion based on DUS participated in this study. Therefore, CTA and contrast-enhanced MRA are routinely used as second reference mini-invasive methods. Although DSA is still considered a gold standard with the advantage of enabling an immediate angioplasty, it is accompanied with non-negligible risk and discomfort for the patient. On the contrary, some singular studies, using ultrasonographic hemodynamic criteria in an exact examination protocol, have found that the ultrasonography and Doppler sonography results were highly comparable with those of DSA ( 15, 16). Some studies reported CTA and contrast-enhanced MRA as more sensitive methods for detection of vertebral stenosis ( 12), while others showed a low degree of concordance between CTA or MRA on the one side and ultrasonography on the other side ( 13, 14). With technological improvements in CTA, MRA, and US methods, the accuracy and sensitivity of these methods have improved and the need for angiography as a gold standard has been questioned in some investigations ( 7- 10). DSA usually is performed for final approval as a gold standard protocol due to its high X-ray dose delivered to patient and personnel. After the ultrasonography examination and determining suspected patients, the second choice is either CTA or MRA. However, its accuracy depends on the user skill and especially on a well-defined examination procedure ( 11). This is a noninvasive and non-ionizing imaging method of hemodynamic measurement. The first method of choice for screening and diagnosis of carotid artery stenosis is ultrasonography (US). However, due to the relatively small percentage of patients who have indication of angioplasty, the diagnostic procedures should be as non-invasive and safe as possible. The advantage of angiography is that the angioplasty procedure can be implemented at the same time. With the progress of noninvasive or minimally invasive diagnostic techniques like ultrasonography, MR angiography (MRA), and CT angiography (CTA), as various dose reduction techniques ( 6), the detection and evaluation of stenosis lesions improved ( 7- 10). Angiography procedure has one of the most invasive protocols and has very high delivered X-ray doses to patient and personnel ( 5). Common angiography or digital subtraction angiography (DSA) is the gold standard protocol for diagnosis of the carotid artery stenosis. Early diagnosis of this disease can lead to better and more effective treatment ( 3, 4). BackgroundĬarotid artery disease or carotid artery stenosis is one of the common causes of stroke or cerebrovascular accident ( 1, 2). We also showed that measurement of PSV could be a good parameter for evaluating carotid stenosis like PSVr in Doppler ultrasonography.ĭoppler Ultrasonography CT Angiography Digital Subtraction Angiography Carotid Artery Stenosis 1. We showed that the accuracy of CTA and Doppler ultrasonography was appropriate in comparison with DSA results for male patients with carotid stenosis ≥ 50%. Significant correlations were found in our study between CTA/DSA and DUS/DSA.
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