Duplex Ultrasonography to Predict Internal Carotid Artery Stenoses Exceeding 50% and 70% as Defined by NASCET: The Need for Multiple Criteria

Carotid duplex scanning is being used more frequently as the sole preoperative diagnostic imaging modality for patients considered candidates for carotid endarterectomy. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has demonstrated the benefit of surgical treatment in patients with carotid stenoses exceeding 70%. The purpose of this study was to determine duplex criteria that accurately predict carotid stenoses exceeding 50% and 70% as defined by NASCET arteriographic criteria. One hundred forty-one patients (264 carotid arteries) considered surgical candidates were prospectively studied over a 2-year period by use of both duplex scanning and digital subtraction cerebral arteriography. Carotid artery stenosis was determined by a single radiologist using NASCET arteriographic criteria. Peak systolic velocity (PSV) and enddiastolic velocity (EDV) were measured in the internal carotid (ICA) and common carotid (CCA) arteries by use of duplex scanning. ICA/CCA velocity ratios were calculated for PSV and EDV. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. PSVICA/CCA provided the highest sensitivity, and EDVICA the highest specificity in this study. Arteriographic stenoses exceeding 50% and 70% were reliably predicted with use of these duplex criteria. It is concluded that duplex criteria can predict carotid stenoses exceeding 50% and 70% as defined by NASCET arteriographic criteria. These criteria should be independently validated by other vascular laboratories.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68440/2/10.1177_153857449903300508.pd

Noninvasive evaluation of hand circulation before radial artery harvest for coronary artery bypass grafting

AbstractObjective: Radial artery harvesting for coronary artery bypass may lead to digit ischemia if collateral hand circulation is inadequate. The modified Allen's test is the most common preoperative screening test used. Unfortunately, this test has high false-positive and false-negative rates. The purpose of this study was to compare the results of a modified Allen's test with digit pressure change during radial artery compression for assessing collateral circulation before radial artery harvest. Methods: One hundred twenty-nine consecutive patients were studied before coronary artery bypass operations. A modified Allen's test was performed with Doppler ultrasound to assess blood flow in the superficial palmar arch before and during radial artery compression. A decreased audible Doppler signal after radial artery compression was considered a positive modified Allen's test. First and second digit pressures were measured before and during radial artery compression. A decrease in digit pressure of 40 mm Hg or more (digit ΔP) with radial artery compression was considered positive. Results: Seven of 14 dominant extremities (50%) and 8 of the 16 nondominant extremities (50%) with a positive modified Allen's test had a digit ΔP of less than 40 mm Hg (false positive). Sixteen of 115 dominant extremities (14%) and 5 of 112 nondominant extremities (4%) with a negative Allen's test had a digit ΔP of 40 mm Hg or more with radial artery compression (false negative). Conclusion: Use of the modified Allen's test for screening before radial artery harvest may unnecessarily exclude some patients from use of this conduit and may also place a number of patients at risk for digit ischemia from such harvest. Direct digit pressure measurement is a simple, objective method that may more precisely select patients for radial artery harvest. Additional studies are needed to define objective digital pressure criteria that will accurately predict patients at risk for hand ischemia after radial harvest. (J Thorac Cardiovasc Surg 1999;117:261-6