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Ultraschall Med 2000; 21(5): 199-205
DOI: 10.1055/s-2000-7985
ORIGINAL CONTRIBUTION/ORIGINALARBEIT

Georg Thieme Verlag Stuttgart ·New York

Optimising the Use of Carotid Duplex Sonography[*]

 B. Frauchiger1 ,  P. Nussbaumer2 ,  C. Roedel3 ,  J. G. Magun4 ,  K. Oehy5 ,  D. Staub6
  • 1MD, Chairman of Department of Internal Medicine, Division of Angiology, Kantonsspital, Frauenfeld, Switzerland
  • 2MD, Senior Registrar, Department of Internal Medicine, Division of Angiology, University Hospital, Basel, Switzerland
  • 3MD, Senior Registrar, Kantonsspital, Division of Angiology, Kantonsspital Frauenfeld, Switzerland
  • 4MD, Consultant of Neurology, Department of Internal Medicine, Kantonsspital, Frauenfeld, Switzerland
  • 5MD, Head of Departement of Surgery, Kantonsspital Frauenfeld, Switzerland
  • 6Registrar, Department of Internal Medicine, Division of Angiology, Kantonsspital, Frauenfeld, Switzerland
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Publication History

Publication Date:
10 November 2003 (online)

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Summary

Aim: We analysed factors influencing diagnostic yield and treatment and their potential for optimising the use of carotid duplex sonography (CDS). Method: Patients referred for CDS were divided into three groups: 1: high likelihood of carotid symptoms, 2: suspected presence of asymptomatic carotid lesions, 3: other indications. Clinical data, the grading of stenosis and the therapeutic consequences were analysed. The efficiency of diagnosis was tested with an algorithm. Results: 344 patients were included. Groups 1, 2 and 3 contained ≥ 1 pathological finding in the carotid or vertebral system in 68 %, 86 % and 55 % respectively, whereas high-grade stenoses or occlusions of the internal carotid artery (ICA) were detected in 10.8 %, 16 % and 3.6 % respectively. Age > 50, > 1 risk factor, carotid murmur and concomitant vascular disease were associated with a significantly higher diagnostic yield. Subsequent treatment in groups 1, 2 and 3 involved carotid thromboendarterectomy in 6.4 %, 2 % and 0.7 % respectively and the start of treatment with a platelet aggregation inhibitor in 9 %, 30 % and 17 % respectively. The optimisation algorithm would have saved 21 % of CDS scans. Conclusion: Clinical pre-selection criteria determine the diagnostic yield of CDS. The potential for optimisation depends on the treatment regimen chosen for asymptomatic stenoses and secondary prophylaxis.

Optimierter Einsatz der Duplexsonographie der Carotiden

Studienziel: Die Carotis-Duplexsonographie (CDS) ist nicht invasiv, unbelastend und hat eine hohe diagnostische Präzision. Diese Vorteile und offene Fragen zum Vorgehen bei asymptomatischer Stenose der Arteria carotis interna (ICA) bergen grundsätzlich die Gefahr unkritischer und zu weit gefasster Indikationsstellung. Wir untersuchten deshalb prospektiv die CDS bezüglich diagnostischer Ausbeute, therapeutischer Konsequenzen und allfälliger Optimierungsmöglichkeiten. Methoden: Zur CDS zugewiesene Patienten wurden in drei Gruppen aufgeteilt: 1. karotideale Symptome wahrscheinlich, 2. mögliche asymptomatische Karotisläsionen, 3. andere Indikationen. Klinische Daten, Stenosegradierung und therapeutische Konsequenzen wurden protokolliert und die Effizienz der Diagnostik mittels eines Algorithmus überprüft. Ergebnisse: 344 Patienten wurden eingeschlossen. In Gruppe 1, 2 und 3 fanden sich in 68, 86 und 55 % der Fälle ≥ 1 pathologischer Befund in der Karotis- oder Vertebralisstrombahn, hochgradige Stenosen oder Verschlüsse der A. carotis interna (ICA) bei 10,8, 16 und 3,6 % der Patienten. Alter > 50, > 1 Risikofaktor, Gefäßgeräusch und begleitende vaskuläre Erkrankung waren mit einer signifikant höheren diagnostischen Ausbeute vergesellschaftet. An therapeutischen Konsequenzen resultierten in Gruppe 1, 2 und 3 in 6,4, 2,0 und 0,7 % eine Thrombendarteriektomie der ICA sowie die Neumedikation eines Thrombozyten-Aggregationshemmers in 9, 30 und 17 % der Fälle. Die Anwendung des Optimierungsalgorithmus hätte 21 % der Carotis-Duplexsonographien eingespart. Schlussfolgerung: Klinische Vorselektionskriterien bestimmen die diagnostische Ausbeute der CDS. Das Optimierungspotential hängt entscheidend vom Vorgehen bei asymptomatischer Stenosierung und der Konsequenz bezüglich sekundärprophylaktischer Maßnahmen bei neu entdeckten arteriosklerotischen Manifestationen der extrakraniellen Strombahn ab.

Key words:

Doppler sonography - Duplex-Carotid-Optimise

Schlüsselwörter:

Doppler-Sonographie - Duplex - Arteria carotis - Optimierung

01 Parts of the data were presented at the three countries meeting of Angiology in Berlin, Germany, 9/9/98.

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01 Parts of the data were presented at the three countries meeting of Angiology in Berlin, Germany, 9/9/98.

Beat Frauchiger, M.D.

Chairman of Department of Internal Medicine Kantonsspital

8500 Frauenfeld Switzerland

Phone: Tel.++ 41 52 723 72 50

Fax: Fax:++ 41 52 723 75 77

Email: E-mail:beat.frauchiger@kttg.ch

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