Clarifies the correlation between different angiographic grading methods and duplex ultrasound criteria for internal carotid artery stenosis to guide surgical intervention decisions.
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May standardize carotid stenosis grading for decisions; leaves open prospective outcome validation before practice change.
The stroke risk reduction benefit of surgical intervention in carotid occlusive disease has been validated in multicenter trials for various angiographically defined lesion severity categories. The two divergent angiographic grading methods used for internal carotid artery stenosis in these trials have caused confusion in the clinical application of their recommendations. Moreover, while today's highly accurate carotid duplex scanning can obviate the need for preoperative angiography in many cases, the duplex criteria must be tailored to achieve sufficiently reliable results on which therapeutic decisions can be made. This review offers a clarification of the discrepancies between the angiographic grading techniques and how their measurements of percent stenosis correlate to the duplex criteria needed to support the treatment decision-making process for carotid obliterative disease.
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Nicolaides et al. (1996) studied this question.
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