What question did this study set out to answer?

To determine how various noninvasive and invasive imaging strategies influence appropriateness ratings for carotid endarterectomy compared with standard contrast angiography.

March 23, 2004Neurology

Importance of the imaging modality in decision making about carotid endarterectomy

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Why the study?

How do different imaging modalities for determining internal carotid artery stenosis affect the appropriateness ratings for carotid endarterectomy?

Population

203 clinical scenarios where carotid endarterectomy might be performed for internal carotid artery stenosis

Comparison

Determination of stenosis using noninvasive… vs Conventional angiography

Authors

TKTheodore A. KennedyArizona Geological Survey HQHude QuanPreventive Cardiology WGWilliam A. GhaliPreventive Cardiology

Discussion

Member takes

Implication

Concordant noninvasive imaging maintains equivalent appropriateness ratings to angiography in symptomatic carotid stenosis; leaves open prospective outcome validation before practice change.

Key Points

To determine how various noninvasive and invasive imaging strategies influence appropriateness ratings for carotid endarterectomy compared with standard contrast angiography.
An expert panel evaluated 203 clinical scenarios for carotid endarterectomy using formal appropriateness criteria methodology.
Each scenario assessed internal carotid artery stenosis across five imaging strategies: conventional angiography, Doppler ultrasound alone, CT or MR angiography alone, concordant noninvasive tests, and discordant noninvasive tests.
Of 203 clinical scenarios, 33 were classified as appropriate under conventional angiography; concordant noninvasive studies produced identical appropriateness ratings in symptomatic disease.
Single noninvasive imaging was deemed appropriate only in severe symptomatic stenosis, whereas single or discordant noninvasive tests downgraded other scenarios to uncertain or inappropriate.
In asymptomatic carotid artery stenosis, only scenarios with severe stenosis confirmed by concordant noninvasive studies or CTA/MRA alone were judged appropriate for surgery.

Structured PICO

How do different imaging modalities for determining internal carotid artery stenosis affect the appropriateness ratings for carotid endarterectomy?

Population

203 clinical scenarios where carotid endarterectomy might be performed for internal carotid artery stenosis

Intervention

Determination of stenosis using noninvasive imaging strategies (ultrasound carotid Doppler only, CTA or MRA only, concordant results from two noninvasive studies, or discordant results from two noninvasive studies)

Comparator

Conventional angiography

Outcome

Appropriateness ratings for carotid endarterectomy

The choice of imaging modality to determine carotid stenosis significantly influences the perceived appropriateness of carotid endarterectomy, with concordant noninvasive imaging performing similarly to conventional angiography in symptomatic patients.

Cite This Study

Kennedy et al. (2004) studied this question.

synapsesocial.com/papers/6a8a7c5dfce154801ccbef3b https://doi.org/10.1212/01.wnl.0000115097.61748.bf

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Implication

Concordant noninvasive imaging maintains equivalent appropriateness ratings to angiography in symptomatic carotid stenosis; leaves open prospective outcome validation before practice change.

Importance of the imaging modality in decision making about carotid endarterectomy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Importance of the imaging modality in decision making about carotid endarterectomy

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider