Berat ACU, Muharrem TOLA, Tülay ÖLÇER, Işıksalan Nilgün ÖZBÜLBÜL, Ensar ÖZDEMİR, Sarper ÖKTEN, Mehmet YURDAKUL

Asemptomatik, %60-99 karotis arter stenozu tanısında renkli Doppler ultrasonografi

Amaç: Bu çalışmanın amacı renkli Doppler ultrasonografi (RDUS) ile asemptomatik %60-99 internal karotis arter(ICA) stenozunda tarama testi olarak ve anjiografiye gerek kalmadan karotis endarterektomiye(CEA) karar verdirici bir test olarak kullanıma uygun RDUS kriterleri oluşturmaktır. Gereç ve Yöntem: CEA yapılması düşünülen 95 hastaya RDUS ve dijital substraksiyon anjiyografi (DSA) incelemesi yapıldı, inceleme sonuçları karşılaştırılarak %60-99 ICA stenozunu en doğru belirleyen RDUS parametresini bulmak için ROC(Receiver Operating Charasteritic) eğrisi analizi yapıldı. Bulunan bu parametre üzerinden %60-99 ICA stenozunda tarama testi olarak kullanımı için yüksek sensitivite ve negatif prediktif değer (NPD), kesin karar verdirici test olarak kullanımı için ise yüksek pozitif prediktif değer (PPD) ve spesifisiteli RDUS kriterleri belirlendi. Bu kriterlerle anjiyografi gereksinimini azaltacak algoritim şeması oluşturuldu. Bulgular: Asemptomatik %60-99 ICA stenozunu belirlemede pik sistolik hız(PSH) ve pik sistolik hız oranı (PSHica/cca) ICA stenozunu belirlemede daha yüksek test performansına sahipti. PSH,DSH, PSHica/cca için ROC eğrisi altındaki alan sırası ile 0,980, 0,955 ve 0,979 olarak bulundu. PSHica/cca ile tarama ve kesin karar verdirici test olarak kullanımı için optimum kriter olarak sırası ile 2,6 ve 4 değerleri bulundu. 2,6 değeri için sensitivite %96, spesifisite %90, PPD %78, NPD %98 ve doğruluk %91 idi. 4 değeri için sensitivite %67, spesifisite %99, PPD %97, NPD %88 ve doğruluk %90 idi Sonuç: RDUS un bu kriterleri, %60-99 ICA stenozunun ta-ramasında faydalı olmakta, hem de gereksiz girişimleri azaltarak profilaktik CEA dan strok azaltıcı faydanın artmasını sağlamaktadır.

Diagnosis of 60-99% carotid artery stenosis by color Doppler ultrasonography

Diagnosis of 60-99% Carotid Artery Stenosis by Color Doppler Ultrasonography Aim: The aim ofthis study was to determine duplex criteria using color Doppler ultrasonography (CDU) as a screening and definitive diagnostic tool in asymptomatic 60-99% internal carotid artery (ICA) Stenosis Materials and Methods: 95 consecutive patients considered for carotid endarterectomy were studied with CDU and digital subtraction angiography. Results of two tests were blindly compared. CDU measurements were subjected to receiver operating characteristic curve analysis to determine the most accurate parameter predicting 60-99% ICA Stenosis. Using the most accurate parameter determined, CDU criteria were determined with a high sensitivity and negative predictive value for screening, and a high positive predictive value and specificity for identifying patients for CEA without angiography. Results: Peak systolic velocity(PSV) and ratio of the internal carotid artery to common carotid artery (PSVica/cca) had high test performance in determining for ICA Stenosis. Optimal criteria for using as a screening and definitive tests were PSV ica/cca of 2,6 and 4, respectively. A PSV ica/cca of 2,6 had a sensitivity rate of 96%, specificity rate of 90%, positive predictive value(PPV) rate of 78%, negative predictive value(NPV) rate of 98%, accuracy rate of 91%. A PSVica/cca of 4 had a sensitivity rate of 67%, specificity rate of 99%, PPV rate of 97%, NPV rate of 88%, accuracy rate of 90%. Conclusion: This criteria of CDUS will be beneficialin screening of 60-90 % stenosis and also increase the benefit of minimizing the stroke resulting from prophylactic CEA by decreasing unnecessary interventions.

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