Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Nov 25:12:48.
doi: 10.1186/1476-7120-12-48.

Utility of carotid duplex ultrasonography in a general inner-city hospital

Mihir Barvalia  1 , David Silber, Michael DiVita, Abinash Joshi, Najam Wasty, Marc Cohen
Affiliations

Utility of carotid duplex ultrasonography in a general inner-city hospital

Mihir Barvalia et al. Cardiovasc Ultrasound. .

Abstract

Background: Carotid Duplex Ultrasonography (CDUS) is one of the non-invasive imaging modalities used to evaluate for carotid artery stenosis. However, it is often used in patients with coronary artery disease (CAD), peripheral artery disease (PAD), before heart surgery, syncope and non-specific neurological symptoms although its value is unclear. Our study aimed to further investigate the yield of CDUS in these conditions.

Methods: A retrospective analysis was conducted on 827 consecutive carotid ultrasounds ordered between March 2013 and August 2013 at Newark Beth Israel Medical Center. Clinical characteristics such as age, sex, smoking status, systemic hypertension, diabetes mellitus, CAD, PAD, carotid bruit and indications for carotid ultrasound were included. Significant cerebrovascular disease (sCBVD) was defined as greater than or equal to 50% diameter reduction in internal carotid arteries (ICA) or any degree of occlusion in vertebrobasilar system.

Results: Only 88 out of 827 (10.6%) patients had sCBVD. Using logistic regression analysis we identified age greater than 65 years (OR 2.1, 95% CI 1.2 to 3.7; P=0.006), carotid bruit (OR 7.8, 95% CI 3.6 to 16.6; P <0.001) and history of prior carotid endarterectomy or carotid artery stenting (OR 5.8, 95% CI 2.3 to 14.8; P <0.001) as significant predictors of sCBVD.

Conclusions: Significant carotid artery stenosis is more likely in patients 65 years and older, presence of carotid bruit and prior CEA. On the other hand, it has low diagnostic yield in less than 65-year-old individuals, syncope and non-focal neurological symptoms. This highlights the need for better risk prediction models in order to promote optimal utilization.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Percentage of sCBVD across all risk factors. Legend: sCBVD – significant cerebrovascular disease. H/o CEA/CAS – history of prior carotid endarterectomy or carotid artery stenting but asymptomatic and without carotid bruit. CAD/PAD – Coronary Artery Disease or Peripheral Artery Disease. DM – Diabetes Mellitus. HTN – systemic hypertension. TIA – Transient Ischemic Attack. Miscellaneous – non-focal neurological symptoms and before cardiac surgery. OHT – Orthotopic Heart Transplantation.
See this image and copyright information in PMC

References

    1. de Weerd M, Greving JP, Hedblad B, Lorenz MW, Mathiesen EB, O’Leary DH, Rosvall M, Sitzer M, Buskens E, Bots ML. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke. 2010;41:1294–1297. doi: 10.1161/STROKEAHA.110.581058. - DOI - PMC - PubMed
    1. Halliday A, Harrison M, Hayter E, Kong X, Mansfield A, Marro J, Pan H, Peto R, Potter J, Rahimi K, Rau A, Robertson S, Streifler J, Thomas D. Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet. 2010;376:1074–1084. doi: 10.1016/S0140-6736(10)61197-X. - DOI - PMC - PubMed
    1. Mahmoudi M, Hill PC, Xue Z, Torguson R, Ali G, Boyce SW, Bafi AS, Corso PJ, Waksman R. Patients with severe asymptomatic carotid artery stenosis do not have a higher risk of stroke and mortality after coronary artery bypass surgery. Stroke. 2011;42:2801–2805. doi: 10.1161/STROKEAHA.111.618082. - DOI - PubMed
    1. Cohen GI, Aboufakher R, Bess R, Frank J, Othman M, Doan D, Mesitha N, Rosman HS, Szpunar S. Relationship between carotid disease on ultrasound and coronary disease on CT angiography. JACC Cardiovasc Imaging. 2013;6:1160–1167. doi: 10.1016/j.jcmg.2013.06.007. - DOI - PubMed
    1. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK, Jr, Cardiovascular Health Study Collaborative Research Group Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med. 1999;340:14–22. doi: 10.1056/NEJM199901073400103. - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources